NZCOM media release re: Primary Unit in ChCh

NZCOM media release following media coverage re: Primary Unit in ChCh

The Canterbury West Coast Region of the NZ College of Midwives has been in constructive and positive discussions with the CDHB for many months regarding maternity care for women in the region. Furthermore we are aware that women have also been included in these discussions. We do not wish to pre-empt the outcomes of those discussions, however, following comments in the media today and yesterday suggesting that “women and midwives prefer births to be at Christchurch Women’s Hospital because there was medical, specialist and paediatric support available”, we feel we have been left with no choice but to comment on behalf of our member midwives. More than 90% of midwives in New Zealand are members of the College.

Firstly, Christchurch Women’s Hospital is a facility that has been designed for women or their babies who need some level of medical care. There is a growing amount of robust, respected and peer reviewed research* confirming that a tertiary hospital like ChCh Women’s, is not the best place for women who are in good health at the start of their labour, to have their babies. The CDHB is acting responsibly in the view of the College, by reviewing this current large body of literature around outcomes and places of birth, to inform the decisions they are making in relation to services they provide to women having their babies in Canterbury.

The results of the *Birthplace Study (UK), published in the British Medical Journal in November 2011, was a large, extensive and well-respected study which found when it came to outcomes for babies, that there was no difference between babies born in midwifery-led units and obstetric units, however there was more intervention for the woman if she was low-risk (had had an uncomplicated pregnancy) and gave birth in an obstetric hospital, such as ChCh Women’s. There is a great deal of evidence that giving birth in a midwife-led setting supports normal birth and low intervention, and the ‘Birthplace Study” is the most robust evidence to date demonstrating that giving birth in a midwife-led unit does not increase the risk of harm for the baby, or mother.

Canterbury currently has three midwifery-led (primary) units and has had these for many years. The midwives who work in these units are health professionals, highly skilled at assessing and working alongside women, and the College will have the same expectations of the midwives who will work from any new unit.

A new modern birthing facility is another example of how the District Health Board is reviewing all of its services post earthquake and the NZ College of Midwives is highly supportive of such a move. In fact all DHBs will need to start to consider how they will provide such services for women.

There will always be a need for the maternity services and expertise provided by staff in a tertiary unit (hospital) such as ChCh Women’s. The College of Midwives is also aware that it may take some women time to feel comfortable having their baby in a primary unit. We see this as an opportunity for women who are well and healthy at the end of their pregnancy to commence their labour at a new primary birthing facility and then if the need arises, be transferred to Christchurch Women’s. No-one wants to see mothers and babies compromised and currently with so many women going to ChCh Women’s there are huge pressures on their services.

It is unconstructive for some commentators to scaremonger at this stage of the discussions. There are many things that have yet to be discussed and resolved, including ambulance services for such a unit. The College of Midwives locally and nationally intends to continue working and supporting the CDHB to progress their future plans for reviewing all birthing services in the region and to ensure that the outcome is something all Cantabrians can be proud of, well into the future.

Norma Campbell
**Acting CEO
NZ College of Midwives

**CEO Karen Guilliland is currently out of the country

Notes:
Physiological issues re: child birth (simply explained)
When a woman has a baby, her body triggers each stage of labour, with physiological triggers. If the stages are interrupted or an intervention affects the natural physiological trigger, it can affect the next stage, which can cause problems requiring additional intervention – this is called the “cascade of intervention”.

Research sources:
Birthplace Study (UK) Published British Medical Journal November 2011:
This was a large prospective study undertaken in England and involving 64,538 women from all across England who had low risk pregnancies. The aim was to compare the outcomes for the women and babies with the place of birth. The measures they used were type of birth, perinatal (period immediately preceding and following birth) mortality and poor health for the baby due to issues such as meconium aspirate, neonatal encephalopathy, fractures. The birth places settings included home birth, stand alone midwifery led units (primary units) alongside midwifery led units and obstetric units (maternity hospitals). NZCOM 2012

^ Tracy SK, Wang A, Black D, Tracy M, Sullivan EA (2007) Associating birth outcomes with obstetric interventions in labour for low risk women. A population based study. Women and Birth; (2):41-48) /
http://sydney.edu.au/nursing/staff/academic_staff/sally_tracy_2010.shtml

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