TOP STORY: Midwives poorly trained: Doctor

ALEX HICKEY
Some independent midwives are poorly trained, cannot spot a difficult labour and may be partly responsible for a dramatic increase in caesarean sections, says Napier obstetrician Peter Jennings.
As a parting shot, the newly retired peri-natal expert also points the finger at the profession for producing too many poor-quality graduates from midwifery school and believes it is to blame for "a lot that is wrong with modern maternity care".
The former specialist, who has spent 33 years practising in Hawke's Bay, went on to say that midwives needed to obtain more on-the-job training before being allowed to practise. "Young (midwifery) graduates need to get at least two years' more experience in a hospital setting or overseas, before they can practise independently," he said.
There were some "wonderfully skilled, competent senior midwives" practising in Hawke's Bay but new and junior graduates were inadequately trained".
"They have three years of training, but I would equate their skills to a sixth-year medical student and I would prefer the medical student, who can at least learn from their mistakes."
But Dr Jennings' comments have started a war of words with the New Zealand College of Midwives, who label them "ill-informed and irresponsible".
The college's chief, Karen Guilliland, said his misgivings about midwifery were a symptom of a "pathological mistrust" of a women's profession.
At every level the health of mothers and babies was better now than it had been for most of Dr Jennings' lifetime, she said.
Mortality rates for mothers and babies were decreasing, fewer women needed ante-natal admissions and fewer babies were admitted to neo-natal units.
Fewer Maori, Pacific Island and low-income babies were premature, or had a low birth weight and more women expressed "stronger and stronger" satisfaction in relation to their birth experience.
Dr Jennings also said long labours and tired midwives were contributing to the growth in the number of mothers having caesarean sections.
In the early 1970s, less than 5 percent of all live births in Napier were delivered through this method - that figure had now risen to about 20 percent.
Midwives had to be with a patient for the duration of the labour, which could last for up to 36 hours, and that must have some effect on their judgment.
"It is, generally, physically impossible for a midwife to be there for 18 to 24 hours of labour and to make an objective medical decision about a patient's care (at the end of that)," he said.
Conversely, women who would benefit from seeing a specialist were not being referred because midwives could not recognise the signs of a difficult birth.
They had to confine their talents to the 80 percent of births which were normal and leave the other 20 percent to specialists, he said.
Ms Guilliland said caesarean rates were rising worldwide, yet countries such as Australia (26 percent) and Germany (27 percent) had no independent midwives.
"Somewhere in all this, surely we can recognise midwifery has had a positive effect. It is not unusual for the old school to mistrust the new -it is even more usual if that old school is male and a doctor."
Dr Jennings had a long and consistent history of disliking the role of the midwifery profession in attending women in childbirth, she said.
There once had been a belief that only doctors could make safe decisions about childbirth but that had changed.
Maternity was not medicine but a normal life stage for most women.
Sadly, the evidence in maternity showed that medicine had, and would, cause harm when applied to well women, she said.
Midwives were better trained than they had been in the past but perhaps this generation was not so obedient or so subservient and Dr Jennings had difficulty with that, Ms Guilliland said.