Sharron Cole: Midwife care under constant, careful scrutiny

Pregnant women have every right to expect a safe and emotionally satisfying experience. Photo / Thinkstock

Opinion

I lost my first baby. What made that time more traumatic was a disjointed medical system that treated pregnant women like patients, and sent new mums home from hospital to learn on the job or deal with the emotional scars of loss on their own. I was lucky. I had a good doctor. Many women in the 1960s and 1970s were not so lucky.

Up until mid-twentieth century most women gave birth at home. The hospitalisation of birth saved lives that in the past would have been lost. But it was often a lonely and clinical experience.

I wanted to do something about this fragmented approach, and see it replaced with something kinder and healthier. We needed a system that supported women from the early days of pregnancy to their first days back at home with a new baby, until the Well Child nurse took over care.

The midwife was the one constant professional who could walk beside a pregnant woman from day one.

A lot has changed since my day. Continuity of care is the norm. Every birth is attended by a midwife, and she (or he) is now the lead professional for healthy women with straightforward pregnancies, and the key co-ordinator of the woman's care. Even when there is a need to transfer care because of complications or risk, the woman's midwife remains a key person in the team of doctors and hospital staff.

Pregnant women have every right to expect a safe and emotionally satisfying experience.

Mostly this works well, and is the envy of other countries where pregnancy services are still fragmented. But sometimes things go wrong. That's why our modern system includes a regulatory authority, the Midwifery Council, which makes sure midwives are competent and fit to practise. As chief executive I lead a team whose job is to keep people safe.

We set high standards for the education and conduct of midwives, and we expect them to deliver quality care. We make sure they keep their knowledge and skills up to date by requiring them to test their professional standards on a yearly basis. If a midwife falls short we can act quickly to bring her up to the required standard, or remove her certificate to practise.

Any expectant mother can check on our web site to see if a midwife is currently registered to practise.

This is how we maintain trust in the profession.

There have been a few tragic cases recently where mothers or babies have lost their lives. This makes us stop and check our processes. Sometimes there was nothing any health professional could have done. Sometimes the midwife has made mistakes or not followed referral guidelines which advise a midwife when more specialised care is required.

Are we doing enough to keep the public safe?

When we receive an official notification raising concerns about a midwife's competence we act promptly. The midwives have a right to know that a complaint has been made and to defend themselves, but if we have reason to believe that a mother and a baby could be at risk, then we can act immediately to suspend a midwife, or to put in place "over the shoulder" supervision so that midwife cannot work alone.

If we need to improve our processes, we do. In recent years, this has included lengthening the midwifery course by a year, and increasing the number of hours spent training in hospitals.

I'm pleased to say, most mothers and their partners have positive experiences. They feel they have a tough advocate in the health system with their midwife.

Our maternity model is unique to New Zealand because of the leading role that midwives play, and for that reason it's highly scrutinised, here and overseas. International evidence, including the highly regarded Cochrane Database of Systematic Reviews and the Lancet medical journal, shows the model to be successful and safe. Comparative data produced by the Perinatal and Maternal Mortality Committee shows our outcomes in terms of safety are among the best in the world.

Most New Zealand women want a midwife to be their champion of care in the hospital and the community. Evidence shows that this is the best way to keep mothers and babies safe. But rest assured, any medical professional who fails in that duty will be held accountable.

• Sharron Cole is chief executive of the Midwifery Council.