Margaret Shanks: Mothers in for shock giving birth

COMMENT

Are you aware of what is happening to maternity services in central Auckland? You need to know before it's too late.

As a practising GP and GP obstetrician, I am concerned about what is happening to women's ability to choose the personnel, the place and the circumstances of pregnancy, birth and after-birth care.

I am a mother of six and the only remaining female GP obstetrician in central Auckland. I regard with trepidation the prospect of the National Women's Hospital move to the new Auckland Hospital at Grafton.

I have worked and gained my obstetric qualification at National Women's. All my antenatal care, labour and the delivery of my six children were there and, as an obstetrician, I have delivered about 1200 babies there over the past 13 years.

National Women's has been a positive, woman and baby-friendly place for me and my patients. Visits there before the birth familiarise the mother and her family with the room layout, facilities, parking, people and all the other aspects so important to feeling confident on the big day.

Knowing all the staff there have the same goal of providing a good birth experience and good outcome gives confidence to mothers. Sadly, the facilities have been allowed to deteriorate and become shabby because of the planned move to Grafton.

What is the rationale for the shift? Earlier it was stated that because National Women's was structurally unsound it would be demolished. Not so - it is to be used for administrative staff.

Reasons such as the "centralisation of laboratory services" and the "availability of tertiary specialists for the very sick woman" have now been advanced.

But maternity care needs to be built round a "wellness" model rather than this illness model because the vast majority of women have a healthy, natural birth experience.

Now a pregnant woman has to find for herself a lead maternity carer out of a dwindling supply of obstetric providers. This is no mean feat. For example, having chosen National Women's as her lead maternity carer, she must then attend the antenatal clinic at the Greenlane site.

In labour she has to get to the Grafton site, which is surrounded by traffic-clogged roads, find a carpark - if she's lucky - and, in a very public hospital foyer, negotiate her way to the ninth floor where the delivery unit is situated.

After the delivery, regardless of whether it is night or day - possibly 3am - she will have to take her new baby back to her car and be driven to Birthcare in Parnell for two days of postnatal stay before discharge.

Three hospitals in one day sounds like, and is, a sophisticated adult game of musical hospitals thought up by our health planners. The prize is having your baby wherever you are when the music stops.

Be prepared, fathers: you are now more likely to be delivering your babies in the car, in a carpark or in a lift.

Furthermore, as a GP trying to provide a continuous and high standard of maternity care, I must drive between all these sites and grapple with traffic, parking and all the rest of the unnecessary stress for a reducing maternity fee (most of my colleagues have stopped offering maternity care for these very reasons).

Why do I continue? Because as a family GP I am passionate about caring for families. Satisfaction comes from helping women to make their choices about their relationships, contraception, family planning and pregnancy care.

I attend to their pregnancy, antenatal care, labour management, delivery and postpartum care. I experience the confidence that mothers gain from consistent care from a lead maternity carer who has delivered not one but several of their children and is also their GP and their children's GP.

Women want this choice. But there has been an erosion of funding for GP obstetricians without acknowledgement of the role of the family GP in the continuity of care of the whole family.

With fewer providers and more people working on rosters, women already feel their care is fragmented. This will be made worse by the introduction of a number of sites.

The essence of a good birth experience for the mother, and a good outcome for the baby, is a welcoming, safe environment and the knowledge that the person qualified to care for her is able to handle any emergency that may arise. Without this, more postpartum depression and complications will ensue.

I would love to see health managers thinking of women's needs in their planning. It is important that women have the choice again of where and how and by whom they are cared for.

Hamilton, Christchurch, Wellington and Sydney have their own women's hospitals. Why must the women of central Auckland miss out? Is it too late to save the National Women's Hospital or to provide another single site for combined antenatal, intrapartum and postnatal care?

Is it too late to reverse the trend of exiting maternity providers? Is it too late to put women's needs before fiscal demands? Is it too late to create choice again for women?