Pregnant women may have to pay for urgent doctor visits under plans for maternity shake-up

Currently, GPs, obstetricians and midwives who are not a woman's lead maternity carer can claim fees for one-off urgent pregnancy or postnatal care. Photo / 123rf.com

Women who are pregnant or recently gave birth would have to pay for urgent visits to doctors or after-hours medical clinics under proposals being considered by the Ministry of Health.

In a move that has alarmed doctors and patient advocates, health officials are proposing to withdraw public funding for these unscheduled doctor visits — which number about 30,000 a year — and to instead make urgent care the responsibility of a woman's lead maternity carer, typically a midwife.

At present, GPs, obstetricians and midwives who are not a woman's lead maternity carer can claim public funding for one-off urgent pregnancy or postnatal care. Under the proposed change, this funding would end.

Experts warn the inevitable consequence of the move is that costs will be passed on to women, who may still want to visit a doctor when they need to be seen quickly.

The controversial proposal is part of a wider overhaul of how primary maternity services are funded.

The College of General Practitioners warned the move could have "serious unintended consequences for women and babies", because a doctor is often the best or most accessible option for their urgent care.

"The ministry considers it the responsibility of the LMC [lead maternity carer], their backup and practice to provide 24/7 on-call support systems to meet this need," the ministry's consultation document, released last year to set out how new funding of $85 million over four years, allocated in Budget 2020, might be spent.

Under the proposals, midwives would be expected to coordinate with DHB services in an obstetric or other health emergency, and with Healthline if a woman needs urgent but not emergency clinical advice. If a woman is outside her home region, the midwife would direct them to local DHB services.

Jenn Hooper, founder of Action to Improve Maternity (AIM), which helps families affected by poor maternity care and advocates for system-wide improvements, said the changes would create further barriers to care, including for women experiencing mental health issues. More treatment options and pathways were needed, she said, not fewer.

"They [the ministry] seem to have had no consideration of outcomes for the women and babies that this entire system is meant to be built around," Hooper said. "It's just another example of how devalued women are in our health system. It's only in words that they are women-centric."

The College of General Practitioners, which represents more than 5500 GPs, expects the change would mean women seen for pregnancy care after the first trimester would have to be charged, or the service provided gratis.

A shortage of midwives in many areas would struggle to absorb an extra 30,000 consultations, the college warned in its submission to the ministry. It was also unrealistic to expect women to travel often long distances to access DHB services.

In a submission to the consultation, the NZ Medical Association said the range of issues for which pregnant women see their GP includes threatened miscarriage, morning sickness, hypertension and mental illness. The direction of the proposed changes "appears to signal the Government pulling out of funding free universal maternity care with serious implications for equity and access".

"The DHBs only offer backup services and don't have the capacity to see every urgent pregnancy case who cannot get hold of their LMC," the association's submission said.

Alison Eddy, chief executive of the College of Midwives, said currently midwives weren't funded for urgent callouts for non-labour and birth related issues. That needed to change, but the college didn't support the proposal to take funding away from GPs for seeing women in the same situations.

"Any practitioner who is providing primary maternity care - be they a GP or midwife - should be funded fairly and equitably for that. We do have a supposed principle that primary maternity care should be free for women, and if a woman is presenting at a GP for care, that should be funded. Similarly, if a midwife is called out at 3am for something not necessarily labour-related, then that should be funded as well...we don't want this to be an 'us versus them'. We don't want to create barriers for women."

A ministry spokesperson told the Herald more than 900 submissions of the wider changes have been received, and are currently being reviewed, before the ministry will draft a list of regulations for how services are to be provided and paid for. The expectation is that those will be in place by September.

Because this process was ongoing, the ministry declined to comment on whether the proposal to stop funding non-LMC urgent care remained, or was likely to be abandoned or modified. It acknowledged feedback opposing the change. Associate Minister of Health Dr Ayesha Verrall will sign-off the final changes.