17 Feb 2014

Maternity unit faces 'unique pressures'

4:47 pm on 17 February 2014

The agency responsible for training health workers says Counties Manukau District Health Board is addressing its shortage of maternity staff, but the DHB faces unique health and ethnic problems.

An independent report, commissioned by the board, on the experiences of Maori and Pacific mothers at Auckland's Middlemore Hospital found many of the women felt staff stereotyped and judged them.

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Health consultants Pacific Perspectives surveyed 61 Maori and Pacific mothers, who are at the highest risk of having their baby die.

Health Workforce New Zealand executive chairman Des Gorman said no other board faces staff shortages like Counties Manukau, and pressures on it are unique.

"There's a high prevalence of pregnant women with gestational diabetes and other morbidity. There have been some challenges over time in continuity of care and there's also been some traditional difficulty in recruiting a workforce with is culturally and ethnically well suited to the community it serves."

DHB director of strategic development Margie Apa told Radio New Zealand's Morning Report programme about 15 percent of their midwives are Maori or Pacific, and she would like to have a proportion closer to the 47 percent of birthing population from those groups in the region.

Ms Apa said the DHB had invested in scholarships over the past four years to try to increase the Maori and Pacific workforce.

Counties Manukau has the highest rate of stillborn and newborn deaths of any board in the country and many women are not using antenatal services until after 20 weeks or they go into labour.

Report findings

Women studied in the survey by Pacific Perspectives reported feeling judged by the staff at Middlemore. The report cited one who had her five month scan but did not go back to the hospital because she didn't like the way she was treated.

"I never had a midwife, due to when I did have a midwife she was very judgemental because of my age, being pregnant young … so I felt uncomfortable so I just basically looked after myself through the whole nine months and gave birth in my own bathtub."

Some women interviewed described a culture focused on timeliness and efficiency and one said she was asked to leave just four hours after giving birth.

A self-employed midwife in South Auckland for the past 18 years, Ady Priday, helps about 60 women give birth each year at Middlemore and said getting a bed for her patients after they've given birth can be difficult and most stay in for just 24 hours.

Counties Manukau DHB said that is not acceptable will be asking staff if similar situations are happening and what can be done differently.

Ms Apa said a close eye will be kept on staff to make sure they are treating the women with respect. "Most (staff) think they are communicating in a professional manner but the way it might come across may not be what they intended."

She added the report was of 61 mothers only, and there are 3500 Maori-Pacific births in the district.

The report recommends Counties Manukau urgently fix its poor service for Maori and Pacific mothers by addressing staff shortages and tailoring a training programme to improve customer service.

In addition to dealing with recruitment issues, the DHB said it had its set up a workforce group to work on the communication problems.

Improvements made - training agency

The agency responsible for training health workers says it has already made improvements to try to boost the number of Maori and Pasifika people working in maternity care.

Health Workforce New Zealand executive chair Des Gorman says there have been problems recruiting a workforce that reflects the population but a range of initiatives have been taken.

Professor Gorman says the pressures on the Counties Manukau DHB are unique.

He says the area is a high-needs one, with a high prevalence of women with gestational diabetes, and there have been problems recruiting a workforce that reflects the population.