Editorial: Mothers and babies deserve answers after unsettling study about the health of newborns

New Zealand's maternity system is led by midwives, who replaced doctors as lead carers in 1990.

Editorial

In one of the most comprehensive studies of its kind, Otago University researchers have found unexpected differences in health outcomes for babies born under the care of midwives compared with those looked after by doctors.

The study in a New Zealand context is important because of the central role midwives in the care of pregnant women and the delivery of their infants. New Zealand's maternity system is led by midwives, who replaced doctors as lead carers in 1990. The research is the first major safety review of the system since then.

The five-year study of more than 244,000 infants born between 2008 and 2012 found that mothers with medical-led care had babies with lower odds of adverse health outcomes at birth.

The peer-reviewed research found that babies whose mothers were in the care of doctors had 55 per cent lower odds of oxygen deprivation during delivery, 39 per cent lower odds of neonatal encephalopathy, which is associated with brain injury, and 48 per cent lower odds of poor health at birth.

The results are concerning and cry out for a response, which the Ministry of Health is undertaking. Pregnant women in this country need reassurance that the choice they
make in their maternity carer will not affect the health of their baby. Clearly the dominance of midwives in the New Zealand system means the ministry must quickly
find out whether things need to change.

One group has been quick to suggest where reform could start. The group Action to Improve Maternity, which says it has helped more than 700 families with babies damaged at birth, argues that newly-graduated midwives need closer supervision. There is no reason this suggestion should not be part of the ministry's review.

The ministry has described the findings as unexpected and suggests they
contradict international evidence. Be that as it may, the important next step is to determine as swiftly as possible whether there are measures which could lead to better outcomes for babies and their families. If these are identified, then they should be implemented as soon as possible.

The midwife profession sometimes appears overly defensive in the face of criticism. The
immediate response of the College of Midwives on this occasion was to suggest the findings reflected a rich-poor divide in that outcomes for babies from deprived circumstances were worse that those in better-off environments.

The college argued that women under the care of midwives often had a number of risk factors associated with their pregnancy. These women were often in remote areas, were Maori or Pasifika, were younger, smoked, overweight and engaged late with their lead maternity carer.

But the study authors - one of them a former midwife - say their research accounted
for these factors. They argue the findings show the need for an investigation to discover the reasons for the apparent excess of adverse outcomes in midwife-led care.

The challenge for the profession is to accept this conclusion and work with all parties - the ministry, researchers and families - to ensure that all babies have the best possible start in life, regardless of who is on hand at their birth.