By Eva Corlett for RNZ
Midwives in the Wellington region say they are working themselves to physical and emotional exhaustion because if they don't, mothers and babies could die.
The Capital and Coast DHB confirms that of its roughly 60 full-time midwifery staff, 17 positions are vacant - nearly a third of the workforce.
One midwife said not a single application was made for eight new graduate positions funded for the region.
Because of a serious shortage of midwives at Capital and Coast DHB, the maternity service has gone into "code black" three times recently - meaning it cannot look after any more women.
An experienced midwife at the DHB said staff were at breaking point.
"It's not fair to say 'yes you can come to work, for x amount of pay but we're going to work you until you're just about collapsed on the ground'.
"And you're going to come back the next day because you're worried that if you don't someone's going to die because there isn't another person, or you're worried that your colleague is going to be exposed to an unreasonable workload.
"So you keep coming in, and you keep coming in and you do get trapped in that loop."
Staffing is so poor, they are having to pull nurses in to help and experienced midwives are being stretched beyond their capacity, she said.
"It will just take another ambulance coming in for the camel's back to be broken.
"[We're] having to figure out how we can utilise every single resource around us, to the point where we don't have any resources left. We just don't have the staffing or the bedding capacity to be able to do that at the moment."
The midwife said the lives and wellbeing of mothers and babies are at risk.
"You don't just want people not to die, you really want to make sure that they're well. It's not just 'do no harm', it's also 'do no harm and do some good'. And we are not getting that 'do some good' bit.
"With the crap pay and the horrible conditions, it's the 'do some good' bit that keeps making you want to go back to work."
She feels hopeless and demoralised.
"It's a shame because it's something that I'm really, really good at. The fact that I feel almost unable to do that any more is such a heartache for me."
The midwife said there was no silver bullet, but changes must be made, starting with a collective agreement the staff have now been waiting nine months for.
"The disservice that the DHBs are showing to the nursing and midwifery staff and how they value us - and the way they value us is through pay and conditions - it just feels like another kick in the pants really.
"[I have] recognition for my colleagues because they are amazing, but dismay at the DHB's lack of negotiation."
She added that it was extremely hard attracting students into midwifery.
One problem is that
Students are expected to be on call 24/7 and cannot take up a job to support themselves through their studies.
Culture of 'increasing responsibility but less autonomy'
Another midwife said there was a "culture of fear and misery".
"Every shift there are midwives complaining about their impossible workload.
"There is no supervision for midwives despite us asking for this again and again. We work with families who suffer bereavement and those who are traumatised and have issues like domestic violence and drug dependence, we don't get special training for this or the chance to debrief about our experiences," she said.
"We work in a culture where we are given increasing responsibility but less autonomy - every move we make is watched by management who come down on us like a ton of bricks if we don't fill out the myriad paper forms correctly, who expect us to give heart and soul to the women and babies we care for yet who don't seem to value our own time or lives."
She said students were not able to be mentored because of workload and were used as another pair of hands and they did not choose to stay with the DHB.
Midwives have long featured on Immigration's regional skills shortage list, but even overseas, the workforce is dwindling.
Employed midwives' union Meras co-leader Caroline Conroy told Nine to Noon it was time to build a strong local industry.
"We can't rely on international recruitment to create a sustainable midwifery workforce. We know that.
"In April 2019, there was a midwifery accord signed between the Ministry of Health, Meras and the DHB leaders and the NZNO [New Zealand Nurses Organisation] to create a sustainable midwifery workforce."
That includes bringing people through schools of midwifery and supporting those students better.
An urgent meeting between Meras, Charity Midwives and the DHB's midwifery director is being held today to discuss the problem.
The DHB admitted there was a problem with staffing and space at its maternity facilities.
It said it had processes in place to manage this and parents could have confidence they would be well looked after.
It added that many of the staff that had left its unit had gone into other parts of the DHB or were now working as midwives in the community.