Allegations of racism and discrimination among New Zealand's midwives and staff in maternity care are raising concerns about cultural sensitivity in the workforce.
Several women have told RNZ International that they have experienced or witnessed racism and discrimination in maternity care.
One woman said she had been made to feel "dirty", while another said a midwife's dealings with a mother's family member had been inappropriate.
The New Zealand Midwifery Council said the claims were distressing and efforts were being made to address cultural competence in the profession.
Figures from the Midwifery Council show registered midwives are dominated by European ethnicities, who make up nearly 90 percent.
One midwife, Sharon Robinson, said health care providers often didn't seem to be aware that their comments were discriminatory.
She had been disheartened to overhear midwives' comments about mothers who were obese, she said.
"Unfortunately when midwives are saying things like 'All islanders come over and want to eat McDonald's and Kentucky Fried Chicken every day...'
"I have seen women, behind their backs, midwives say, 'You know I think she just sits on the beach and eats taro all day' ... and that's just not acceptable."
Ms Robinson said even if negative comments were made in private, the attitudes affected the quality of care given and the safety and confidence a mother felt.
Tongan-Māori mother Vasiti Palivi agreed, and said her experience at a private birthing unit was horrible.
"The receiving midwife sort of said some derogatory remarks to me," she explained.
"My waters had broken in the car so I was somewhat covered in birthing fluids and so when I arrived she sort of made me feel really quite inferior. She made me actually feel like I was dirty."
Academic researcher Ruth De Souza said there needed to be more cultural understanding and awareness within maternity care in New Zealand.
She recalled an incident during her work at an Auckland hospital where staff had asked a young teenage boy to find out how much blood his mother had discharged.
"I had asked if we could get an interpreter and the person who was in charge that day said, 'No, we're going to have to use her family.' And the only person that could be used was her son," she said.
"So we were asking her son if he could ask his mother about how much blood was on her pad. And it just felt so inappropriate and I was so upset because you know, that seemed all kinds of wrong for me."
Labour's social development spokesperson, Carmel Sepuloni, said she was not surprised at some of the stories.
"I just have had my own experiences and I know that others have had experiences as well where they were made to feel slightly uncomfortable," she said.
"And at the time when you're experiencing that, you do question in your head - hang on a second, is this because I'm brown?"
She was 20 years old when she went into labour with her eldest son and said she felt dismissed when she called for a nurse to ask for pain relief.
"I can remember really clearly her kind of rolling her eyes at me, sitting down on the bed next to me. Holding my hand and looking me in the eye and saying to me 'Just remember, you're the one that wanted to have this baby.' Then she smiled and then got up and walked out."
"I can remember thinking 'I can't believe she just said that to me'."
New Zealand Midwifery Council chair Dr Judith McAra Couper said the council had clear frameworks around cultural safety within the practice.
"It's really distressing for me to hear as a midwife and, to be honest, as a New Zealander," she said.
"For us in Midwifery Council, we have really clear expectations around cultural competence. Cultural competence is valued as highly as clinical confidence. So midwives are really aware of what's expected of them."
Of the 3033 registered midwives last year, only 174 were Māori and 31 were Pacific.
Dr De Souza said often systems could be insensitive without meaning to be.
"What we often forget is that the healthcare system has its own distinctive culture and it reflects the dominant culture's values and practices."
Dr McAra Couper said the council and the New Zealand College of Midwives took cultural competence and safety seriously.
"It would be naive not to think that as an academic, that in our institutions, there aren't hegemonic interests at play, absolutely. You just need to talk to anybody from another culture who goes into our institutions."
"But in terms of midwifery, we work really, really hard that women who are different from us - that we work with them in ways that are respectful, and acknowledge what they need and their families need."
'I definitely try really hard'
Midwife Moon Carson said she had not seen any racism within the workforce and believed some comments were misconstrued.
"There's quite a few midwives that have come from overseas that work here and I don't think that they're as aware and I don't think they try as hard to have a cultural awareness," she said.
"I know I definitely try really hard to make sure I'm culturally aware of things."
Ms Robinson said women in labour were sensitive and vulnerable, and it was important for them to feel culturally, spiritually, physiologically and medically safe.
In New Zealand, babies are entitled to 10 free visits from a midwife and a Well Child worker in their first year.
But recent figures from the Ministry of Health figures, from 2014, show over 4000 babies received no visit within their first 12 months.
Of that group, Māori and Pacific made up 43.5 percent and families classed as the most deprived were 34 percent.
Ms Sepuloni said those figures were concerning.
"Off the top of my head I can imagine that part of the reason would be that for Māori and Pacific, there are real housing issues.
"So transience would be an issue and whether the health sector is keeping up with where our women are moving to after they have babies."
Dr McAra Couper said the council was working on a series of workshops that would address cultural competence and safety, and it would like to see more diversity among midwives.