The New Zealand College of Midwives has sent a strong message to the Government on behalf of community-based midwives.

College Chief Executive, Alison Eddy, says all midwives have seen their workloads increase considerably over the last four to five weeks, particularly community-based midwives. Despite this there has been no financial support offered to this key frontline health workforce.

“We are quite frankly baffled as to why other primary health workforces have received financial support and acknowledgement of the effects on their work and yet midwives, whose workloads and income are significantly affected, continue to be ignored,” she says.

Ms Eddy said in an email sent late yesterday to Ministers in the Covid Cabinet that although midwives remain focussed on keeping mothers and babies safe, after more than four weeks of higher workloads there is concern for the wellbeing of workforce, “I am not sure how much more they can absorb,” she says.

As well as rapidly adapting how they provide care, to incorporate a mix of virtual and face-to-face assessments, community midwives have found themselves needing to fill gaps left by the withdrawal of, or reduced access to other services.

“For example, many obstetric consultations are taking place virtually now, instead of in person, so any follow up or monitoring is falling to community midwives to complete. Well Child services are also being provided virtually at present, complicating the usual handover process. Women are experiencing a high level of anxiety about the potential impact of Covid-19 on their pregnancy and birth, so midwives are fielding a much greater than usual number of calls and contacts, and birth plans are changing with more women seeking homebirths,” says Alison Eddy.

Women are being discharged from hospital earlier after birth, meaning an increase in the number of contacts for post-natal care including and more post-surgical care for women who have had c-sections. Even simple things like reduced access to laboratory testing and ultrasound scanning services have meant more time spent by midwives ensuring women have access to these tests.

“LMC (Lead Maternity Care) midwives, based in the community, are self-employed but have no way of being paid for additional work they do (they are paid via Section 88),” says Ms Eddy. “It is an issue we have been negotiating with the government for more than four years, and the pandemic has acutely highlighted the problem,” says the College Chief Executive.

In early March 2020, prior to the Covid-19 outbreak, an NZIER report noted considerable inequities in the way community midwives were funded. It found that community midwives were working up to 26% more than was expected of a full time equivalent (FTE). Essentially these key frontline health professionals were working for up to 26% of the time, for free.

“With the extra work midwives are doing now in the Covid-19 environment, that unpaid work has increased significantly. Despite repeated requests and communication with the government and ministry about this matter, they continue to fall on deaf ears. And still babies keep coming and still our midwives keep absorbing the costs and doing work for nothing,” says Ms Eddy.

Following is a copy of the text from an email sent to Covid Cabinet Members from Alison Eddy, Chief Executive NZ College of Midwives, on the afternoon of 19 April 2020:

Firstly I want to acknowledge the government’s leadership and decisive action in response to the Covid-19 outbreak. This has clearly helped to protect the health and wellbeing of New Zealanders, and we are now in a favourable position to move forward.

However, the government’s prompt response meant that a number of rapid changes occurred, including (but not limited to) a number of health providers withdrawing all face-to-face care, or retrenching access to services considerably. Community midwives had to quickly implement a new model of service delivery too, adopting a mixture of virtual / telephone and face-to-face contacts with women and families in their care.

However, the vast majority of the work that community midwives undertake cannot be deferred. Many of the physical assessments and ‘hands on care’ needed are time critical. They simply cannot be provided via a virtual consultation or be deferred until the end of lockdown. As well as rapidly adapting how they provide care, community midwives have needed to fill gaps left by the withdrawal of other services. They have worked hard (and continue to do so) to ensure ongoing access to critical services such as 24/7 care for acute presentations, blood tests, ultrasound scans and higher-level obstetric care, during the lockdown period.

Community midwives have also had to provide more care post-natally as women are being discharged much earlier from hospital following birth, and increase their travel to see women who are needing to self-isolate in their own homes, source PPE when it hasn’t been available (paid for out of their own pocket), spend many additional hours reassuring women, deal with increases in family violence and mental health concerns, and incorporate practice changes related to Covid-19 into their day-to-day care.

They are focussed on keeping mothers and babies safe, however after more than four weeks, I am not sure how much more they can absorb.

In early March 2020 prior to the Covid-19 outbreak, an NZIER report noted considerable inequities in the way in which community midwives were funded. This report found that community midwives were working up to 26% over their contracted FTE; essentially these key frontline health professionals were working for up 26% of the time, for free. The report noted that changes to the current funding model could reduce inequitable outcomes for mothers and babies.

NZIER REPORT CAN BE READ HERE

With the extra work midwives are doing now in the Covid-19 environment, that unpaid work has increased significantly. And still babies keep coming and still our midwives keep absorbing the costs.

Prior to the Covid-19 pandemic, the Ministry of Health and the New Zealand College of Midwives were working towards a resolution of longstanding issues regarding fair and reasonable pay under the terms of a mediation agreement. The agreed date for implementing changes under this agreement is July 2020. The sustainability of our world-leading community midwifery services, which were already challenged due to under resourcing, are now even more challenged. I note with interest that the government has allocated considerable financial support for other provider groups who have lost income due to a drop in demand for services, as well as resourcing them to better manage this new environment in which we all find ourselves.

It is deeply perplexing as to why no support for community midwives, who are continuing to provide an essential service in our communities and hospitals, and who have indeed experienced an increase in workload and additional costs associated with this, have not been prioritised by the government for additional support.

We are a female workforce (98% are women) of more than 3000 whose clientele is entirely women. For a government that has spoken so positively about addressing the gender inequity in New Zealand as well as the importance of the early years of a child’s life, the lack of financial support for community midwives in the Covid-19 environment only adds to our bafflement.

Please hear us. Please support our midwives, women babies and wider community.

Yours sincerely

Alison Eddy

Chief Executive

College of Midwives

Video message from Alison Eddy to politicians can be viewed here

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