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"Why New Zealand
needs a Maternity Manifesto?"

Why does New Zealand Need A Maternity Manifesto

This manifesto was created by representatives of several maternity consumer groups to gain public support for more effective, women-centred and evidence based options of maternity care and policy which are presently not available to support the best beginnings for all New Zealand families.

Some manifesto recommendations have been part of previous individual campaigns; such as pushes for more birth centres, mother-baby unity for sick newborns and the WHO Code.

Though a recent national survey of women, including some whose babies did not survive, showed that a majority of women are satisfied with their maternity care, this is only a snap-shot of some women’s experiences. Some positive feedback of women about maternity care is due to New Zealand’s ‘midwife-woman partnership’ standard of practice which aims to ensure care is relevant as well as consistent with legislative safeguards. This partnership approach and LMC continuity of carer are some of the reasons why NZ midwifery is recognised as a world leader of women centred birthing options. This manifesto seeks to make other aspects of care similarly women-centred where evidence supports this approach.

For example, according to the Ministry of Health (MOH) annual reports of hospital maternity events; “Common interventions used during (‘normal’) childbirth include: induction, epidural, episiotomy, manual removal of placenta and the management of postpartum haemorrhage’. Rather the MOH needs a definition and focus on encouraging women to birth their babies as naturally as possible, increasing normal birth rates should be a MOH target and benchmark of quality maternity services, as it is in the UK countries.

Therefore this manifesto also calls on the MOH to join international efforts[1], [2],  to address issues which contribute to NZ’s growing rates of childbirth  interventions. For example 24.2% of births in 2007 ended with a Caesarean section, up from  11.7%.  in 1988. The MOH says that “Currently, no consensus exists in New Zealand regarding the optimal caesarean section rate for the best health outcomes. However, there is a general consensus that the current rate is too high.”  As part of more appropriate response to increasing intervention rates the MOH needs to inform the public of overwhelming evidence that for each intervention in an otherwise normal pregnancy or labour, mothers suffer one or more poor health outcomes, which negatively impact on the woman’s family, child and/or community.

Growing evidence that place of birth has a dramatic effect on childbirth interventions [3], [4], [5], [6],  and that women report higher satisfaction with their birth experience in “home‐like” environments compared to hospitals needs to inform women’s birth choices and MOH maternity facilities’ development. If women knew these facts it is doubtful that most births (83.7%) in 2007, would have occurred in secondary and tertiary level hospitals. Meanwhile some District Health Boards (DHB) have attempted to close primary units when ‘insufficient’ women have used them, or failed to support or even thwarted efforts by other groups to create new primary birthing units.

New Zealand’s in-activity on these maternity issues contrasts to the UK; there a Royal College of Obstetricians and Gynaecologists (RCOG) Expert Advisory Group said “Too much care is provided within secondary and tertiary settings. Too many babies are born in the traditional ‘hospital’ setting. We need to drive this care back into the community with the appropriate provision of facilities and professionals with appropriate skills.”   Thus, the RCOG is now attempting to educate the UK media and public of the evidence behind efforts to increase primary birthing and down-scale or centralise obstetric units.  

New Zealand media’s sensationalising and bias about maternity issues was evident in the reporting of one unfortunate birth outcome. Yet apart from an apology from Maori TV there has been no real effort to redress this unbalanced coverage of maternity issues.  As a public health and safety measure the NZ government, parliament or  its agencies should address any unbalanced media which leads to social distrust of normal birth or reinforces the myth that hospital is the safest place to give birth [7], [8].

Dr Pat Tuohy (Chief Advisor Child and Youth Health) acknowledged in 2003 [9] the need to extend New Zealand’s Rooming-in of mother and baby policy for healthy newborns and sick children, to the care of sick or premature babies in neonatal units, but nearly a decade later there is still no national plan to support this evidence based practice.

Despite indisputable evidence of breast milk’s superiority, increasing public support for informal milk sharing and international recognition that human milk banks meet the fundamental human rights of our most vulnerable infants[10]; New Zealand is one of the few nations world-wide without a milk bank. Yet government support of national milk banking would be consistent with many policies and directives promoting breastfeeding as optimal nutrition for all infants [11], [12], [13], [15].

Evidence shows that the failure of several governments to fully implement the WHO Code on the Marketing of Breast-milk Substitutes is counter-productive to the MOH target of increasing the number of New Zealand infants exclusively breastfeeding for 6 months or more. More than twenty years after New Zealand agreed to support this code the parliament still has only enacted an ineffectual voluntary and diluted form.

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