We took the time to ask all major political parties what their views and policies are relating to what matters for our Home Birth Whanau. An email was put together with 5 key issues that we felt encapsulated the kaupapa we have held space for over the past 3 years. These 5 questions will never cover all the points of relevance for all of our community, but we trust these questions will at least give us all some things to reflect on. All major and minor parties were contacted, if no response was received they have not been included – other than the two primary parties. Responses included in no specific order.
I am emailing as a representative of Home Birth Aotearoa, we are a National Trust whose membership spans all of Aotearoa. As the election grows near, we are checking in with your policies, with specific attention to maternity care in New Zealand. Our membership will want to be informed on which parties best support their interests and the needs of our communities. As such we have honed in on our key issues and would like to hear your views on the following.
- Currently under the current HDC code of rights all people receiving maternity care have the right to maternity care with dignity, choice, informed consent and the right to refuse treatment. We want to be assured that any health initiatives relating to maternity and infant care going forwards will preserve these rights. We want to be assured that birth choice will not only be preserved, but supported.
- The care that women receive prior to, during and post birth is essential to good outcomes, with benefits that positively impact health far into the future. We know that midwifery care and continuity of care is the highest quality maternity system currently available. This is borne out by international studies and qualitative research conducted in New Zealand. We want to be assured that the government we support acknowledges this, and recognises the wonderful work our midwives do in the community. Currently midwives are not paid enough and the systems that support them are not robust enough. Please tell us how you intend to support midwifery and midwives in Aotearoa going forwards.
- Primary Birth is acknowledged as the gold standard which is best suited to well women in Aotearoa, yet many women are birthing in tertiary birth settings through lack of. This has ongoing costs to the taxpayer, not only in resources being used, but also in terms of increased unnecessary interventions and poorer outcomes for birthing women. How will your party address this issue?
- Parental leave in Aotearoa is insufficient. Research shows that babies and mothers benefit from being allowed sufficient time to bond, breastfeed and recover from birth. The benefits from supporting this essential process are multifaceted – both to the mother infant dyad, but also to whanau and communities with ongoing health outcomes that are measurable. An investment mindset on this issue will ensure good outcomes going forwards, saving health spending in the future. We currently have a decreasing rate of breastfeeding and an epidemic rate of postpartum depression. We want to know what your intentions are with regards to paid parental leave.
- Currently in our maternity care system, not enough is done to support our Maori birthing communities. Traditional birth practices are not always supported, rural communities are under serviced and our midwifery system does not have sufficient Maori midwives to provide cultural birth care. Studies show that women thrive when supported by birth care workers who are from their same cultural background. We would like to see a serious effort to decolonise our birth practices and ensure Maori traditional birth practices are protected and supported. We would like to hear your thoughts on this.
Thank you for taking time to respond to our issues. A prompt response would be valued, we will be distributing these responses to our community.
National: No response
Labour: No response:
- The Green Party agrees but notes that we do support effective, evidence-based policy designed to raise immunisation rates but with individuals consent. Immunisation is an individual medical choice, and shouldn’t be mandatory. All individuals, and parents, should be able to make an informed decision about immunisation.
- The Green Party is highly aware of how work traditionally considered to be “women’s work” is undervalued and underpaid. Midwives are the epitome of this. The Green Party is committed to ensuring that women are paid better in New Zealand. There is increased pressure on midwives due to staff shortages and this is placing further strain on our health system. There needs to be increased professional development of midwives to assist with maternal mental health. We would increase funding to health, but particularly to postnatal services such as increasing community social worker availability. This means that midwives can be freed up to focus on their job.
- The Green Party wants every child to have the best possible start in life. We support research into rising intervention rates and caesarean sections. We are committed to providing information and support for home births for low-risk pregnant women. We would review primary maternity units to see if they could be better utilised to enable women and babies to receive care closer to home. This is balanced with ensuring that all babies and their mother have access to the health care that they need.
- The Green Party wants to help parents when they need it the most, by ensuring they have time and money to focus on raising happy, healthy kids. Too many parents in Aotearoa are struggling to pay the bills and juggle work and family commitments. We want every single Kiwi kid to have a great start in life – regardless of what their parents earn or whether they work or not. To make that a reality, their parents need more time, more financial support, and more flexible work arrangements. Well-supported kids turn into happy and healthy adults.
The ability for parents to choose to care for newborn babies is an essential part of supporting families to develop nurturing relationships. The Green Party would like to see paid parental leave extended to ensure parents are provided with a total of 13 months of paid leave.
The Green Party is also committed to:
- Making the $220 per week Parental Tax Credit available to all families who don’t get paid parental leave. This ensures every baby born in New Zealand gets the same support and makes the system simpler.
- Extend sick leave to be a minimum of 10 days a year, so that parents and whanau have time to look after sick kids
- Ensuring the OSCAR subsidy for after school and holiday programmes is available to all kids from low-income families.
The Green Party believes that parenting is one of the hardest and most important jobs in the world. As a country, we all benefit when parents are supported to give their kids the love and attention they deserve.
5. It is important that Māori practices are accorded respect, are protected, are supported and are accessible to people. There does need to be more Māori birth care workers who work with our communities. New Mums need to be able to relax and be themselves, not to feel judged. Honouring the whānau can be as easy as working with everyone to ensure that they are present at the birth.
There is a shortage of Māori midwives AND midwives trained and knowledgeable in Māori birthing practices. We know that non-Māori midwives are already organically taking onboard some of the common Māori birthing practices such as using alternative methods of cord clamping (muka ties) and disposal of the placenta/whenua – but there needs to be a strong commitment in midwifery training to Māori birthing practices and also to recruitment of Māori midwives to improve service accessibility and delivery. Greens support an investigation into what is needed in this area.
Wahakura is an example of a Māori birth practice initiative which is working really well to lower SUDI. Having solutions that work with culture are win-wins. The Green Party is committed to giving every new born baby a Wahakura – Baby Pod, which includes a safe sleeping place as well as clothes, nappies and bedding.
- Birth choice will not only be preserved, but supported.
2. The Maori Party plans to enact a long term, strategic approach to address the midwifery shortage, analyse crisis points in maternity services and neonatal care and invest appropriately to ensure sustainable whanau wellbeing. We have been advocates for pay equity.
3. The Māori Party Health policy is about Whānau Ora and enabling our whānau and communities to lead healthy lives. We want our whānau supported by an equitable health system. The Māori Party supports Māori community-led based birthing centres, antenatal, maternity and postnatal care services and programmes.
4. As a party, we influenced the increase of paid parental leave from 12 to 18 weeks. We want 26 weeks. We have also extended the application of paid parental leave to women who work part time, and we have had whāngai recognised in the law for parental leave equity. We support taking an investment mind-set to ensure good outcomes going forward. We also recognise the role of motherhood as a transferable set of skills to enhance your career path that should be viewed as an asset.
5. The Māori Party is born of the dreams and aspirations of tangata whenua to achieve self-determination for whānau, hapū and iwi within their own land. Māori are at the bottom of every health disparity and statistic there is. We will continue to tackle the barriers of inequity, increase innovative and efficient health-care, provide more opportunities for education and enable better access to support for those who need it most. The Māori Party absolutely supports efforts to decolonise our birth practices in Aotearoa.
New Zealand First:
- New Zealand First supports the Health and Disability Commission Code of Rights for all people.
2. New Zealand First also share concerns around the underfunding of the maternity sector. This is reflective of a public health system under immense strain. We know that midwives are facing an unprecedented level of stress as demand for services increases and they are forced to do more with less. This is not a safe environment for mothers and babies. Midwives undertake such an important role and we want to ensure that they are operating in the safest system possible; therefore, we have been calling for an inquiry into maternity services. Our hope is that changes can be made to help minimise preventable deaths and permanent disabilities.
3. New Zealand First have been calling for a review of Maternity Services in New Zealand. We need to identify the issues and better allocate resources. We would also ensure that safety considerations are paramount in funding decisions relating to maternity care services and require improved provision of ante-natal classes, maternity services for rural, Maori and Pacific Island women, and the improved monitoring of maternity services.
4. New Zealand First will incrementally extend paid parental leave out to 26 weeks but will allocate four weeks to each parent that is non-transferrable. The remaining 18 weeks can be taken by either parent. It is important that fathers get the recognition as part of the parenting team. At present fathers are entitled to two weeks unpaid leave which has meant that only around 1% are able to take this time with their child. We hope that this support will encourage more fathers to take this time to bond with their children, take on more care and help out mothers following a birth of their child
5. New Zealand First believes that decisions like these need to ensure that safety considerations are paramount, especially in funding decisions relating to maternity care services and we would require improved provision of maternity services for Maori and Pacific Island women. While we respect every individual’s choice of care, it is important that the decision is informed and takes into consideration the safety of the mother and baby.
Democrats for Social Credit:
Democrats for Social Credit response (below) to 5 questions on maternity services;
In response to your questions on maternity care;
I’ll begin with a personal view.
Having become involved as a voluntary patient advocate in 1991, originally regarding the dreadful political/bureaucratic attitude to the frail elderly, I have since been involved in many other areas of advocacy where the “system” (for want of a better word) seems unaware of the reality of life as experienced by many New Zealanders. I think this is at the heart of your concerns too.
So my overall reply to your questions is that myself as the Democrats for Social Credit (DSC) health spokesman, and the party as a whole, believe that LISTENING to the people who are dealing with the reality of everyday life – as distinct from the interminable “planning” bureaucracies, committees and other secretive “official” groups – is the key to improving matters in every field and especially in health. All health services must be based on need, not political dogma.
Regarding your specific questions;
- Regarding the Code of Rights; I have endlessly quoted this for years to politicians and bureaucrats whenever I find the Code being blatantly denied, so yes of course the DSC support choice in maternity as elsewhere, by insisting that the Code be observed in practice and not merely in theory.
- Again the answer is obvious (to us!). As elsewhere those actually giving the care need to be properly paid by providing adequate funding. I should also answer as to how extra funding can be found – which in DSC policy is by providing loans for public works such as new hospital facilities from the Reserve Bank at zero interest when, right now, Cabinet Ministers could if they so chose, provide such loans from the Reserve Bank at zero interest. The savings would be enormous thereby providing funding for the services you are seeking. Government refuse to answer why they won’t do this other than saying “it’s not our policy” (exact quote in letters to me).
- By ensuring that the Minister of Health directs the administrators of the maternity system to listen to what people want and ensure that they are not pushed into services they do not require.
- Again it comes back to the people and groups most concerned being listened to – and ensuring that the current huge waste of funding (I could go on for pages about that!) is directed to where it is needed.
- Yet again choice is the key – and the concerned groups being listened to.
To sum up, in all the above, DSC would ensure that the political/bureaucratic model of recent decades (since 1991 when I first became involved) with successive health ministers taking a non-listening stance, would be changed.
Without wishing to indulge in politician-bashing I have to say that all of the several health ministers I have tried to correspond with over many years give the distinct impression of being mere rubber-stampers of Health Ministry agendas – and I cannot think of any group more distantly removed from life as most New Zealanders live it than the health ministry!
- The code of rights relating to dignity, choice, informed consent and the right to refuse treatment is a powerful document. In practice from what I have seen the awareness of women’s rights around their birth care is improving, however the implementation of the code of rights can be fragmented and as a result women may still be denied choices, particularly in relation to place of birth. Insufficient discussion with women about choices and respect of women’s rights to choose can contribute to this. An informed choice can only really be made in the presence of all of the information needed to make that decision. We need to continue educating and encouraging midwives and other health and medical professionals to have discussions around choices with women and families so that they are fully informed. Without discussing decisions, women do not always have the opportunity to evaluate their options.
United Future believes women and families make choices that they feel are safest for them. We acknowledge that this may not always be in keeping with what the medical industry believes, however cultural safety is also important in achieving satisfying outcomes for women and families and this needs to be protected. We would not support any changes to health initiatives that would adversely impact on these rights.
- With regard to supporting midwives, you are probably aware that as a group midwives have been in mediation with the Ministry of Health over historical gender inequality of pay and working conditions. I am not aware of any other industry that requires a change in an Act of Parliament before they can get a pay rise, but needless to say the situation has been sufferable and is no longer tolerable. A redesign process is currently underway which has given midwives the opportunity to have direct input (through NZCOM) into their pay and working conditions agreement.
United Future would like to see a dramatic increase in pay to reflect the value of the depth of education, knowledge, expertise and extraordinary time requirements of midwives. It is also in appreciation of the absolute importance of care to women and babies during the breadth of their maternity experience. While it is difficult to discuss specifics due to the redesign process currently underway, there are some issues we would be interested in exploring to promote retention which include:
- regular time off call for all LMC midwives, and not at a cost to the midwife,
- additional pay increments based on experience,
- the ability to charge for providing secondary care,
- an end to unpaid work,
- a new support measure where a second midwife can be called in to assist another midwife if reasons arise, regardless of place of birth, and this is funded separately rather than out of the LMCs income,
- the right to revisit and renegotiate pay and conditions.
This is not an exhaustive list, and we support midwives in their pay and working conditions negotiations. The current rate of turnover is saddening and I have heard midwives are reaching burnout after 6 years of practice on average. We need to make this a sustainable working model so we can continue providing continuity of care with the passion that brings midwives into this work in the first place.
In addition to better pay and working conditions, United Future would like to encourage support of midwives to reduce fear in practice. Some high profile media cases in the last few years have inflamed the concern amongst midwives that women’s decisions and right to refuse treatment, or refuse recommendations, may be interpreted as poor practice. This can cause midwives great stress and fear of judgement, affecting their confidence while they would rather be supporting and working with women wholeheartedly. Working in small practices and partnerships, midwives can feel isolated and vulnerable. Yet as a group midwives are motivated to support women’s rights and historically seen as guardians of normal birth. We need to empower and support midwives in their support of women’s rights.
Fear is a complex issue because there is no easy solution, it needs a broad spectrum approach. We could start by scrutinising those who scrutinise adverse outcomes and whether they have pre-determined views. Do we have the right people examining adverse outcomes? Do they take into account the HDC code of rights and practitioners duties to work within this framework? These are important questions because the outcomes of these enquiries inform public opinion and the confidence of midwives to support choice.
To address fear and isolation, I would like to explore the option of a service in each DHB to support local LMC midwives, where part of its role could be providing midwives access to advice on practice issues. This could include how to discuss choices with women, how to document this discussion, and how to safeguard the midwife in supporting the woman’s right to informed choice. The benefit of having a local service is that midwives will have easier access to support from people who know them. If we can have more robustness around the safety and protection of midwives, this will contribute greatly to the freedom of choice women have and their feeling of respect and support in their birth choices.
- In regards to the overwhelming numbers of low-risk women birthing in tertiary centres, I refer to my answer to question one. Education about choices is one solution to this issue. Women have the right to be informed of what choices are available, what these choices entail, and how midwives work with them in labour to enhance and protect their birthing experience. We need to continue promoting the delivery of informed choice care in maternity.
As a primary care setting for well women is gold standard, it is frustrating to see the lack of infrastructure support for underfunded primary care units. Our population is only going to continue to grow and we need to invest in this. Birthing in secondary and tertiary settings increases the chance of intervention. It also takes up space that high-risk women may need to occupy. This can impact on women’s care as they are rushed into postnatal wards or home without the time to enjoy and recover in the immediate postpartum period as the hospital needs their room back.
United Future would like to see more funding for primary units so they can modernise, upgrade and refurbish without needing to beg for new equipment or a tin of paint. We would support an increase in the number and availability of primary care units so that it was actually an option for women. In many areas, including our capital city of Wellington and neighbouring Hutt city, there is no primary care birthing facility. We would look at the staffing status for these units, with special consideration to rural areas, so an increase in use of primary birthing units is feasible and sustainable.
Along with this, we acknowledge the incredible and empowering experience of home birth. Home birth is also very cost effective for the state. Personally when discussing the option of home birth with women, many have declined because of wanting extra expert care in the first few days, and wanting to use the time to bond and recover without other distractions. We could look at supporting home birth by funding additional support to reduce these issues for women. This might include the option of additional caregivers to support women and families in the first few days following birth such as an additional midwife, Karitane nurse, or home help. Funding additional home care would come at a lower price-tag than birthing in a facility and is a conversation we should have.
- We have a long-standing belief that paid parental leave should be 52 weeks duration, and have supported all parliamentary increases thus far for paid parental leave. We will continue to push for 52 weeks of paid parental leave. This would have countless benefits on the health and wellbeing of families such as supporting our breastfeeding recommendations to be realistically achievable, promoting the importance of bonding which is critical in neurological development, and the reduction in stress to the household in that important first year of life.
- I know and work alongside some wonderful midwives both Maori and non-Maori who support Maori women in pregnancy, birth and postnatally, exploring and encouraging cultural practices. The education and awareness of the taonga of birth is supported in midwifery direct entry education which I hope is driving a shift in cultural birth care for the better. Addressing some of the standing issues in the maternity sector, such as continuing to promote the delivery of informed choice, improving support of midwives, and improving the supply of primary care facilities, will help women and midwives to be more empowered and cultural birthing practices protected.
I am aware of the ability for Maori students studying midwifery to apply for some scholarships which helps reduce some of the barriers towards becoming a midwife. However it is a very expensive degree to get through, with incredible demands on time and availability, and these continue to be obstacles that need to be worked on. Getting into midwifery is not the only obstacle though, it is the ability to continue once in the role. We need to retain Maori midwives by improving their pay working conditions and supporting them to support women.
We embrace the principles of Partnership, Participation and Protection set out in Te Tiriti o Waitangi. In keeping with this, United Future would also seek to engage with Maori women and midwives to discuss how we can actively encourage and protect cultural birth practices going into the future.