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There are more midwives than ever before but they aren't practising. Photo/Getty

Why are qualified midwives choosing not to practise?

New Zealand has never had more midwives, but they’re working fewer hours. More than 3300 midwives held practising certificates in the year to March 2019, with about 30% of them choosing to work less than 24 hours a week.

The Midwifery Council’s annual report says that of 1168 community-based midwives, nearly 30% are working fewer than 24 hours a week, and 56% worked between 25 and 40 hours a week. “This means there are insufficient practising midwives at primary, secondary and tertiary levels to provide care to birthing women and their families,” the report said. Only 173 new midwives entered the workforce, short of the target of at least 200 a year.

Just over 80% of midwives who registered to practise in the year to March 2019 are New Zealand graduates – a dip from the 2016/17 high of 85% but up on the 2010/11 figure of 74.6%. However, when Hutt Valley DHB announced it would target midwives from overseas to help fill gaps in its staffing, there was an angry reaction from midwives.

“Recruiting midwives from overseas tells us the DHB just doesn’t get it,” says Siobhan Connor, chair of the Wellington region of the College of Midwives. “Our stats tell us we have more midwives than ever before with practising certificates in New Zealand. However, this skilled and educated workforce is choosing not to practise for reasons that we have been asking to be addressed for more than a decade.”

Alison Eddy. Photo/Supplied

In June, the college’s national chief executive Alison Eddy said better staffing levels, improved working conditions and effective retention strategies for hospital-employed midwives, a sustainable locum service, and better coordination and support for community-based midwives across the country would help.

The College of Midwives launched an historic gender pay discrimination court case against the Government in 2015, alleging midwifery pay breached equity rules under the Bill of Rights Act. It withdrew the action in 2017 as part of a mediation agreement in which the government promised a 6% pay increase and the ability for midwives to co-design their pay structure and working conditions.

In 2018, the Ministry of Health and College of Midwives reviewed midwifery pay and advised Health Minister David Clark that a fair and reasonable income for a self-employed midwife would be $241,000 for fulltime work, taking into account business expenses, on-call hours and responsibility. It would comprise $170,000 base income, $30,000 for on-call costs and $41,000 for business costs.

Eddy says as part of the mediation agreement, the government had an external agency analyse what would be fair and reasonable pay for community midwives and came up with a figure “not a million miles away from that”. Community midwives also want the ability to bargain collectively, in the same way GPs do in Primary Health Organisations.

She says a new funding framework for community midwives is being worked on, with the intention a new model would be announced by July 2020, “but we are aware time frames are slipping”.

Hospital midwives are paid from $54,000 to $77,500 a year, while those in senior designated positions can earn up to $130,000. Community or LMC (lead maternity carer) midwives are paid by fees for the care they provide in each trimester of the pregnancy. In 2017, they received about $2200 per case, with a recommended caseload of around 40 women a year. Out of that comes all their expenses, including their cars, equipment, travel and taxes, and there are no extra payments for on-call hours or particularly long labours.

“The government has a policy around pay equity so why would a women’s workforce that happens to be self-employed for tax purposes not be entitled to that?” says Eddy. “They are public servants, just like employed midwives, with no ability to generate other income – they can’t charge co-payments. They are completely at the mercy of what the government chooses to pay them.”

Anna Clark, the deputy director-general health workforce at the Ministry of Health, says the ministry is focused on designing a commissioning model that’s a sustainable alternative to the current Section 88 notice, which sets out the midwifery fee schedule. She says the ministry is committed to improving New Zealand’s maternity system. Midwifery fees increased 4.9% in the 2019 budget (a cost of $7.4 million annually), on top of the 8.9% rise in 2018.

She says representatives of the ministry, College of Midwives, DHBs and midwifery unions are working together under a Midwifery Accord signed in April 2019 to address issues around safe staffing, increasing recruitment and retention, and supporting students and new graduates. “We acknowledge there is more work to be done to ensure our maternal health system meets the needs of whānau, women and babies. We are determined to do what we can to ensure the ripple-effect of this international shortage doesn’t compromise patient safety.”  

This article was first published as part of the article 'Losing Ellie' in the January 2020 issue of North & South. Follow North & South on Twitter, Facebook, Instagram and sign up to the fortnightly email for more great stories.