Staffing for shifts in Wellington Hospital's birthing suite was "below target" between January and June. Photo / Mark Mitchell
By Ruth Hill of RNZ
Nearly 70% of shifts in Wellington Hospital’s birthing suite were understaffed in the first half of the year, which midwives say is putting pressure on services and making it a constant juggle to provide safe care to women and babies.
Information obtained by RNZ under the Official Information Act shows 69% of shifts in the birthing suite were “below target” between January and June.
Ward 4 North Maternity (which includes antenatal and postnatal beds) was understaffed 40% of the time, while other maternity services, including the community team, were down for 20% of shifts.
A Wellington midwife, whom RNZ has agreed not to name, said it was “scary” having gaps in the birthing suite rosters for most shifts.
“Lead maternity carer midwives are most days contacted via a group text to come in to work in the birthing suite, mostly with community midwifery team labour and births, sometimes to work on the floor as part of the team on shift.”
The birthing suite – which has space for 12 women – was often in Code Red because of lack of staff, which meant clients booked for inductions (usually because of some risk to them or their babies) were frequently bumped for emergencies coming in, she said.
“I get the acuity issue in a very dynamic environment, but if there was more capacity/meat in the system, then postponement/rescheduling would be a rarity, not the norm that it is now.”
As of earlier this month, Wellington’s maternity service had 43 vacancies for midwives.
Co-leader of the midwives union, MERAS, Caroline Conroy, said between 30-40% of positions were vacant.
“So you’re not going to run a ‘business as usual’ service when you’ve got that level of vacancy. It’s going to impact somewhere.”
In a written response to RNZ, Health NZ said “understaffing relates directly to recruitment challenges, which is an international phenomenon”.
“While staffing in some units isn’t as high as we’d like, it is important to note that there are mitigations in place to ensure high-quality clinical care for all patients.”
That included pulling in casual midwives, senior midwives and non-frontline staff like midwifery educators and clinical coaches to “backfill shifts”.
Night shifts were more challenging because those senior staff were not available to fill in, Conroy said.
“So they do try and make sure the night shifts are staffed better, which often leaves the day shifts ‘light’.”
When those shifts got too busy, management must utilise what Health NZ referred to as “the variance response management tool and escalation standard operating procedures”.
Conroy said that sometimes meant postponing inductions and non-emergency caesareans, or discharging mothers and babies early.
“Often the number of staff they have on the shift is not sufficient for the workload, which then pushes them into Code Red, which means workload exceeds appropriate staffing.”
That could happen even when a shift was fully staffed because demand could be “unpredictable”. But it was less likely to happen when services were properly staffed, she said.
Last month, hospital managers were forced to back down on a plan to “reallocate” maternity and gynaecology beds to make room for medical patients coming from the emergency department.
Midwives and obstetricians said the maternity service was often at more than 100% capacity.
However, in a written response to RNZ, Health NZ deputy chief executive Robyn Shearer, who heads the central region, said those particular maternity beds were still “routinely unoccupied”.
“As we have enough resourced maternity beds to meet demand, there are no current plans to recruit additional staff to resource these unused beds.”
Health NZ continued to “actively recruit” to vacant midwifery roles and a small number of specialists (3.7 fulltime positions) in women’s health services, she said.
“Rostering is dynamic and continuously adjusted to meet the demands of patient care.
“While schedules may evolve in the lead-up to a shift due to staff illness or changes in circumstances, patient safety is always our highest priority, and we have effective measures in place to ensure patient safety is always maintained.”
Health NZ confirmed six new recruits were set to join the Wellington service by the end of the year, and it was also hoping to recruit some of the first tranche of 22 graduates from Victoria University’s midwifery programme.
Conroy said that promised to relieve pressure on the existing team.
“As long as they can get to the end of this year, next year should be quite different for them. There’s definitely light at the end of the tunnel.”
Conroy said one immediate way to relieve pressure on the birthing suite would be to turn those “unoccupied” beds in Ward 4 into an observation facility for pregnant women who come in with bleeding or reduced foetal movements and need to be under constant watch.
Currently, they end up taking up rooms in the birthing suite, but if Wellington had an observation ward (like other tertiary hospitals), one midwife could easily manage three or four women, Conroy said.