No easy fix for midwifery situation

Concerning news stories about the state of midwifery services throughout the country are nothing new.

A perusal of the news over several years has depressingly familiar themes — midwives feeling undervalued, underpaid, and driven to despair over short-staffing.

The impact of this on mothers and babies may not always be obvious, but we wonder if awareness of the short-staffing issues affects some mothers’ willingness to ask for help when they need it after birth.

Muddling through with family support is not always an option, nor the best option.

When midwives have caseloads which are too big, does this also have a detrimental effect on the establishment of breast-feeding, particularly for first-time mothers?

In the South we have had more than our fair share of concerning coverage, often to do with issues surrounding rural maternity services, or lack thereof.

At the end of last year, Southern District Health Board chief executive Chris Fleming warned the midwifery shortage posed an "extreme risk" to the board’s services with only 52% of positions filled in Dunedin and 17.3% in Southland.

Registered nurses were being used to support midwifery staff.

Last weekend, this situation hit home when a shortage of hospital midwives meant post-natal patients at the Queen Maternity ward in Dunedin had to be moved elsewhere over three days.

While this was not ideal, plans were in place in advance and the arrangements appeared to work.

It is hard not to have some sympathy for the cash-strapped DHB when we read most new graduate midwives trained here have gone to the North Island because they are getting "attractive packages" there.

In common with many issues in our health system, the midwife shortage is not something which can be solved overnight.

It takes time to train people, and more time and proper oversight for them to become experienced, and good pay and conditions to retain them.

In April 2019 there was enthusiasm about the Midwifery Workforce Accord which the two unions, the New Zealand Nurses Organisation (NZNO) and the Midwifery Employee Representation and Advisory Service (Meras), the district health boards, and the Ministry of Health signed up to.

Despite this commitment to safe and sustainable staffing, none of the parties was under any illusions about there being quick-fixes.

The existing shortage has been exacerbated across the country by midwives resigning after the introduction of the Covid-19 vaccination requirement.

In December it was reported 164 lead maternity carers (out of 1583 across the country) had refused to provide their vaccination status.

Whether that has changed since has yet to be spelled out.

Nor has the situation been helped by difficulties getting healthcare workers into the country from overseas because of limited slots in Managed Isolation and Quarantine facilities.

There has been some progress on pay but there has also been shilly-shallying by the DHBs and the Government over the progress of pay equity bargaining for Meras members and tardiness over paying out agreed lump sum payments.

The parties are now hoping to conclude the pay equity settlement by the middle of this year.

A sensible move, as part of the Meras multi-employer collective agreement, has been the establishment of a paid role for student midwives as maternity care assistants, who will undertake housekeeping and care assistant duties in the maternity setting.

Workforce sustainability is one of five aspects to the national Maternity Action Plan, developed in 2018 and adapted since, which aims to strengthen and transform the maternity system.

The initiatives, some of which will take until 2024 to complete, include supporting midwives to return to practice and increasing the Maori and Pasifika workforce.

Whether the situation will get better or worse when the sweeping health reforms become a reality is yet to be seen.

In the meantime, all concerned must concentrate on collaboration not conflict to ensure mothers and babies get the best care they can.


Traditionally we rely on supplementing our home grown health workforce with overseas practitioners coming either for short term work or permanent positions. We know that there are hundreds of doctors, nurses and midwives wanting to come here but the government seems set on keeping them out, rather allowing DJs and sports people to come instead. Good to know they have their priorities in line with national needs!