12 Nov 2015

Minister changed mind on midwife training, papers show

9:45 am on 12 November 2015

Photo: 123RF

Former health minister Tony Ryall was poised to make new midwives complete mandatory training stints in hospitals, but dropped the plan after lobbying by midwifery groups, official documents show.

Mr Ryall had sought advice, over at least two years, on getting new midwifery graduates to complete six months, or one year, hospital internships.

But papers obtained by Action to Improve Maternity (AIM) under the Official Information Act show that midwifery groups fought the move, saying that other measures would improve services instead.

The revelation follows the release of a study last month which found babies are more likely to die at birth or soon after if a midwife is in her first year on the job.

Mr Ryall was still considering going ahead with the mandatory hospital training as late as April last year after two coronial hearings raised questions about a new midwife's experience.

But by August Mr Ryall had dropped the idea and instead signed off new conditions for the Midwifery First Year of Practice programme.

The cost for the proposed six-month internship programme was estimated to be $3.2 million across all DHBs compared with $2.5 million a year funding for the existing Midwifery First Year or Practice programme.

AIM has been agitating for several years to get more training for new midwives.

And Coroner Gerry Evans said junior midwives should not work unsupervised for their first 12 months on the job and recommended changes to boost their training and experience in his findings on the deaths of Casey Nathan, who died aged 20, six hours after giving birth to her son Kymani, who died two days later.

The ministry says the Midwives First Year Programme has been strengthened to be mandatory and midwives have mentors who can be called upon when they are needed in clinical situations.

But Jenn Hooper from AIM told Nine to Noon this was insufficient.

AIM: Action to Improve Maternity spokesperson Jenn Hooper

Jenn Hooper Photo: Supplied

"There's an old saying I keep referring to; in theory there is no difference between theory and practice, but in practice there is.

"All these things on paper look all well and good, but the fact of the matter is when you actually go to use them they don't work."

Ms Hooper said if a clinical emergency arose a mentor, who could be some distance away, was no substitute for direct supervision.

Lobbying caused Mr Ryall's last minute change of heart, according to Ms Hooper.

"The advisers that they do have from the ministry, it's our understanding that an awful lot of them are either past or present members of the college so there is an awful lot of lobbying that goes deeper than just the college itself.

"If I was minister [Jonathan] Coleman I'd be watching if the advice I was getting from these people was actually not to fulfil their own agenda, frankly."

Hospital internships were the norm for other health providers, and Ms Hooper could not understand why midwives should be different.

"We're not really sure why the College of Midwives thinks midwifery should be any different, what makes them such special snowflakes? That it's different for midwives, that they can instantly have all this knowledge without it?"

Nine to Noon invited both the College of Midwives and the Midwifery Council to be interviewed but they declined and issued statements.

The College of Midwives' midwifery advisor Alison Eddy said: "Women can have confidence in knowing our midwifery-led maternity system is one of the safest, if not the safest maternity services in the world.

"Consideration was given to a period of compulsory post registration practice within a hospital setting for all new graduate midwives, however this was rejected as being unnecessary and adding no value to the quality of care for women and their babies".

The Midwifery Council said a review of the Midwifery First Year of Practice programme, including the question of new midwives going into hospitals, concluded there was no evidence at all to show that this was the best option for mothers and babies.

Instead the evidence showed the best option was to strengthen the mandatory first year of practice programme. It also said the last year of training for midwives was now around 80 percent clinical practice, in effect an intern year.

Beverley Lawton, associate professor and director of Women's Health Research Centre, University of Otago

Beverley Lawton Photo: Supplied

Womens health researcher and associate professor at the University of Otago, Beverley Lawton recently released the study on the relationship between perinatal deaths and midwives' years of experience.

She is also a member of the National Maternal Monitoring Group and agreed with AIM that direct supervision in a clinical setting was the best option for training novice midwives.

"I think the Australian example is three years in hospital before they are allowed to go and practice independently and get funds from the government.

"It seems very sensible that we have an internship in hospital and get more exposure from one to two years."

She said the current system relied on mentoring which was not the same thing.

"This is mentorship, not direct supervision, direct oversight this is a system issue."

Ms Hooper said the First Year of Practice programme was effective at making midwives feel supported and more confident, but did little to boost competence which she said evidence showed was lacking.

"It's not only opinion, but now evidence with Bev Lawton's study, all pointing for the need for a hospital-based internship."