What Happens when the Midwives are Gone?

By Sian Hannagan
Jun 2018

Midwives in Aotearoa are the single biggest repository of birth knowledge, maternity care, and traditional birth knowledges in our country. The model of care they offer is one of the absolute best. While offering this model of care, they work unsociable hours in all areas of the community with woman and whanau from all areas of life. They are a front line care service, and they are skilled. They are also underpaid.

As time continues, their remuneration fails to keep up with their cost of operation, let alone cost of living. The reality is that in many areas of New Zealand, there is already a midwife shortage. As more and more midwives leave due to financial stress and overwork, we lose a skill base that for the most part is irreplaceable. Detractors of midwifery often suggest that birth should be back in the hands of general practitioners or handed over to obstetricians. Naively they feel that midwives vacating the birth care workspace is a positive thing. Setting aside the reality that these alternatives to midwifery are not best care models for pregnant well, women. It simply will not work.

Neither surgical birth teams, nor general practitioners have the skills base, resources, or infrastructure to support primary birth for all birthing women in Aotearoa. It is not reasonable or practical to outsource all maternity to these already overstretched resources. The cost of meeting birth needs without midwifery would outstrip any expense incurred by simply paying midwives what they are worth. Just ask other medical professionals what recompense they get for working outside of business hours, or if they have to travel rurally to conduct their work. If you are having a challenging time imagining an obstetrician driving two hours to see a birthing woman at 2am in her home – you are not alone. This is not their workspace.
Midwifery care without midwives would be ad-hoc, fractured, and costly. It would also be underskilled. Based on observations of other maternity systems that operate outside of midwifery, there would also be poorer outcomes. Continuity of care is a key predictor of good outcomes and of satisfaction.

Without midwifery women would no longer start seeing a community midwife early in their pregnancy. They would not get home visits, nor would they have someone they could call if they had an urgent concern. They would book into crowded clinics, at specific times, to see a staff midwife or nurse. They would do all of the travelling needed for all appointments – which would instantly put quality maternity care out of reach for our less privileged communities. Labouring at home would not be an option for women in rural settings. Homebirth would not be an option. Post-natal visits would be conducted by a separate service, or not at all.

It is a truth universally acknowledged within in the maternity sector, that when it comes to practicalities, midwives are irreplaceable. So why then are we quibbling over a long overdue pay increase? Surely the small cost to pay midwives appropriately would offset the huge expense of replacing an entire, skilled workforce?