Midwife says standards high but more tuition needed

Debbie Ritz says new midwives should work in hospitals for a year. Picture / Kenny Rodger

Debbie Ritz describes herself as one of the "old ducks" of midwifery.

She is outraged by what she calls the witch-hunt against her profession, but says the training of midwives needs to be extended.

"When you qualify you're quite raw," said Mrs Ritz, who is 47.

She estimates she has delivered more than 700 babies in her 10 years as an independent midwife, after qualifying in 1982 and working in industrial nursing, family planning and then National Women's Hospital's high-risk delivery unit.

Like the College of Midwives, she considers the three traumatic births that have drawn official criticism to be isolated cases of incompetence, but she also believes new graduates need more supervision.

After reporting on two of these deaths, the Wellington coroner called for internships for midwifery graduates and the Health and Disability Commissioner, after investigating the third case, recommended all private maternity practitioners including midwives be brought under hospital safety protocols.

Midwifery graduates who go straight into self-employment after completing the three-year degree, which itself involves delivering many babies, routinely have their practice directly supervised by an experienced midwife, usually for a year.

A number of hospitals also run an induction programme for graduates.

Mrs Ritz said that before new midwives were allowed to practise independently, they should all be employed at hospitals for a year, then be mentored for a year in private practice by an independent midwife. Aside from concerns about training, she said, her profession had been unfairly attacked by obstetricians and others. Statistics on stillbirths and deaths soon after birth indicated that allowing midwives to handle most deliveries independently for more than a decade had improved safety.

"This clearly shows that the midwifery system in New Zealand has worked extremely well."

But Professor Cindy Farquhar, who chairs the Perinatal and Maternal Mortality Review Committee, said the last decade's "gradual improvement" in perinatal statistics had been attributed to many factors.

The college's midwifery adviser, Norma Campbell, indicated that midwifery training was more than adequate.

She said the bachelor's degree provided in-depth training and was followed by regular update education for practising midwives.

She rejected commissioner Ron Paterson's recommendation that the maternity hospital access agreement, which governs private practitioners' use of the facilities, be changed to bring them under hospital protocols.

The agreement was worded to encourage the best practice, she said.

In broad talks about maternity, the Health Ministry on Thursday discussed the agreement with her college and the obstetricians' college, which supports the Paterson recommendation.

The ministry acknowledges the agreement could be improved to enhance co-operation, but it has only just started analysing the issue.

Slightly more advanced are its ideas on integrating maternity into Primary Health Organisations.

THE STORY SO FAR


Last November
* Wellington coroner reported on the deaths of two babies after undiagnosed breech births at home involving midwives.
* Recommendations: midwifery training changes, review of maternity services, greater GP involvement in maternity.


This month
* Health and Disability Commissioner reported on the birth of a baby who later died.
* Criticised independent midwife and hospital doctor and found confusion over who was responsible for the mother.
* Recommendations: independent midwives and doctors should be required to comply with the safety protocols of hospitals where they deliver babies.