Documents obtained by the Herald reveal hospital bosses also want to limit births by women who are under the careof a private obstetrician but who live outside its geographical boundaries - blocking women in West, North, East and South Auckland from using the specialists.
The proposed rules are set out in a draft agreement between Health NZ-Te Whatu Ora and private obstetrician groups - Birthright, Origins, and the Auckland Obstetrics (AOC) - and which has been released under the Official Information Act.
It comes after long-running tension between hospital leadership and private obstetricians, centred on the fact women cared for by the specialists are more likely to have a planned (elective) c-section, which uses more resources at the public hospital.
That dispute appears far from resolved - the Auckland Association of Private Obstetricians told the Herald the draft agreement is substantially out of date and inaccurate.
“Fundamentally, as a group we believe in women’s choice in relation to their own reproductive healthcare and that is the position from which we advocate in all our dealings with Health NZ,” the association said.
New Zealand lacks private birthing facilities, and for decades women looked after by private obstetricians (at a cost of more than $6000) have used Auckland Hospital’s labour and birthing facilities under access agreements with individual specialists.
In 2020 the hospital stopped allowing more private obstetricians to access birthing facilities, citing their high planned-caesarean rates.
That “pause” later ended, but strict new conditions were applied, and discussions with the main private obstetrician groups about a more permanent agreement continued.
In July 2023 an agreement was drafted. This has now been released under the OIA, and sets out the interests of Te Toka Tumai Auckland (formerly Auckland DHB), including that, “women being cared for within the public services provided at Auckland City Hospital do not experience any disadvantage due to the public resource being directed to a private patient who has less clinical need”.
“In other words, Te Toka Tumai’s interest is that private patients are treated or cared for in order of clinical priority and do not ‘jump the queue’.”
Local women who use a private obstetrician may lessen the strain on the system, the report acknowledged, but this wasn’t true for those living closer to other hospitals.
“Te Toka Tumai’s interest is to not serve these women from outside the district.”
The draft document listed the interests of the private obstetrician groups, including an ability to succession plan - let younger specialists join the practices and access Auckland Hospital facilities.
Demand for their services exceeds capacity but the practices are committed to not increasing current annual birth numbers, the document states.
Auckland Hospital wants new rules around private obstetrician access. Photo / Dean Purcell
Only small numbers of women who don’t live within Auckland Hospital boundaries are treated, the practices said, and there shouldn’t be any barrier placed on this access.
“Private obstetricians would like to work within a welcoming, non-judgmental environment and to be recognised by the directorate leadership and the clinical colleagues from all disciplines, as adding value to the women’s services.”
The draft document states both parties agree to “group practices working within an allocated quarterly birth quota, with a stable, or declining caesarean section rate”, and “group practices working within the percentage of the birth quota available to serve women from outside the Te Toka Tumai decile”.
Specifically, each year by March 31 the total number of births to be done by all private obstetricians would be set, based on the median of the previous five calendar years.
“This number gives, for the following calendar year, the annual quota for the combined practices, and the allocation for each group practice, based on their historic share.”
The Auckland Association of Private Obstetricians told the Herald the July 2023 draft agreement is substantially out of date, and declined to comment until the actual guidance was agreed.
Te Toka Tumai Auckland also declined to comment, “other than to say we look forward to working with private obstetricians toward a consensus”. There are currently 31 private obstetricians with access agreements.
The latest available birth statistics are for 2022, when elective c-sections accounted for 18.4 per cent of births, and emergency c-sections nearly 24 per cent.
Private obstetricians tend to have higher elective c-section rates. For instance, mode of birth at term statistics in 2022 for women who hadn’t previously given birth show 182 of the 778 such women cared for by private obstetricians had an elective c-section (23 per cent). That compared to 4 per cent of women using self-employed midwives, and 7 per cent of women under hospital care.
The association of private obstetricians has previously stressed its c-sections are always clinically necessary, and higher rates reflect factors such as their clients tending to be older and women with more complicated pregnancies.
