Midwives left in large numbers from a DHB where a lack of staffing and bed space has been linked to baby deaths, documents show.
Housing costs and witnessing frequent "uplifts" of newborns by Oranga Tamariki (formerly CYFS) added to stress on staff within Counties Manukau DHB's maternity and birthing services.
The Weekend Herald revealed yesterday the DHB had taken urgent steps to improve maternity services after problems like lack of staff and bed space which contributed to the recent death or stillbirth of three babies, and injury and harm to other patients.
Extra staff have been hired, but an internal review last year outlined the challenges in both finding and keeping experienced workers. New midwives were almost matched by resignations, with about 84 full-time positions being taken up over three years, and 77 leaving.
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"Despite large volumes of new midwives commencing work at CM Health over the last three years, resignations have been similar and vacancies remain consistent," the September 2018 report, released under the Official Information Act, noted.
Resignations were mostly people moving into self-employment, taking parental leave or moving out of the area to get cheaper housing, or to work closer to home.
About 40 per cent of experienced midwives were older than 50, the report noted, and there weren't many with three or four years' experience.
Maternity leaders met DHB executives in July last year. Their concerns included Oranga Tamariki uplifting babies "every few weeks", which created "significant emotional stress on women, whānau and staff".
Chief Ombudsman Peter Boshier has announced a wide-ranging investigation, following an attempt by Oranga Tamariki to remove a week-old baby from its mother in Hawke's Bay hospital. The agency was already doing its own internal investigation and the Children's Commissioner had launched a review focused on Māori newborns.
A Counties Manukau spokeswoman said a raft of changes had been made to improve services, including funding extra midwifery graduate positions, and senior midwife numbers in the birthing and assessment unit.
"These roles enable increased 24/7 clinical leadership and support for all employed and LMC midwives, the implementation of a more effective triaging process, and, in conjunction with the medical staff, they provide oversight of the induction of labour clinical management," a DHB spokeswoman said.
Asked if the DHB had concerns or issues with the way "uplifts" of babies were done, the spokeswoman said under the law the overall authority and decision to carry out such action was always with Oranga Tamariki.
"We have guidelines that support the processes for uplift of babies and children, with an emphasis on making this as compassionate as possible for the child and mother/family affected.
"Our child protection and midwifery teams have debriefs following an uplift, and where appropriate we provide feedback to Oranga Tamariki, as well via our forums with all sector agencies."
Caroline Conroy, spokeswoman for the Midwives' Union, MERAS, acknowledged DHB efforts to relieve stresses within its maternity service. Counties attracted a large number of graduates from around the country, she said, and after five years about half were still working there.
"Others return to midwifery jobs in their own communities or work as LMC [self-employed] midwives. The retention of graduate midwives is gradually improving the midwifery staffing situation at CMDHB, and they have also increased the number of senior midwife roles."
Conroy said many other DHBs were contending with a midwifery staffing shortage, and solutions weren't simply more resourcing or better pay.
"The work midwives do needs to be better understood, valued and supported by politicians and policy-makers alike."
Brenda Hinton, spokeswoman for the Maternity Services Consumer Council, an advocacy group for women and families, said midwives were overworked, underpaid and dealing with immense stress, including cases such as the recent deaths at Counties.
"We know we have hundreds of midwives with annual practising certificates who aren't working. Most love their jobs, but they either can't afford to do it, because they've got whopping mortgages, or they're burned out. There doesn't seem to be any co-ordination at ministry level to remedy these situations."