When I read recent commentary questioning the role of midwives I did not feel I had sufficient personal experience to comment knowledgably.  The following post has been contributed by a friend, a mother of two children under 3, both born in Wellington with the assistance of an independent midwife.

Stephen Franks suggests that the recent shift towards midwifery-led services represents some kind of victory for midwives in an ideological battle that has been waged at the expense of the wishes and health of mothers and babies. It was, in fact, strong consumer-led demand that lay at the heart of these changes. Surveys pre-dating the shift showed many mothers (though not all) were unhappy with the type of maternity care on offer, particularly the lack of continuity in the medical professionals encountered throughout the pregnancy, labour and post-natal care. Under the care of a GP, a pregnant woman would typically visit her GP for ante-natal check-ups, would then be supported through the labour by (often changing) hospital midwives she had never met before, the GP would arrive to ‘catch’ the baby, and the post-natal care at home would be provided by another health professional. By contrast, under the care of an independent midwife, ante-natal check-ups are provided by the midwife (often, though not always, at home), the midwife supports the woman through the duration of the labour right through to the delivery, and post-natal check-ups are again conducted at home by the midwife. Where necessary, at any point during the pregnancy or labour, the midwife can call on the specialized care of hospital-based obstetricians.

New Zealand is not alone in the fact that wherever these type of midwifery-led services have been offered around the world, women have voted with their feet. Franks further suggests that this shift towards midwifery-led services has seen as a deterioration in the health of mothers and babies. I doubt any parent would think the changes outlined above worth anything if they had come at such a cost. There is no data, however, nor, from what I can gather from discussion with a senior obstetrician who has served as a Clinical Director at one of our major maternity hospitals, any serious concern among health professionals working in this field that there has been any such decline in outcomes. Blithely making such claims in the absence of any supporting data itself suggests some kind of ideological motivation and is, in fact, cavalier about the wellbeing of mothers, fathers and their babies. Maternity care has always been, and always will be, a swamp of “liability anxiety”. A small number of parents will continue to encounter unsatisfactory care and, as in any medical field, mishaps and errors with tragic results will inevitably occur for a few. Stories of GPs who didn’t even turn up to catch the baby have been replaced by tales of midwives who place undue pressure on mothers to resist pharmaceutical pain relief. And, no doubt, some mothers feel caught between midwives and obstetricians who let their disdain for each others philosophies undermine their professional practice. The gap that has been left by the withdrawal of GPs has been felt particularly strongly in rural areas. Midwives, like many other health professionals, including GPs, are overstretched in some regions. This, however, is a long way short of the alarmist picture painted of a crisis in maternity care in this country.