Midwife shortage: risks for mums and babies
Understaffed maternity services are pressured to discharge mothers and newborns before they are ready.
Mothers and babies are at risk because maternity units are under increasing pressure to discharge patients early, the NSWNMA has warned.
NSWNMA General Secretary, Brett Holmes, said major hospitals were experiencing significant shortages of midwives which put “enormous pressure” on working midwives.
Recently, vacancies included 28 FTE (fulltime equivalent) positions at Westmead Hospital, 10 at Wollongong, 16 at Royal North Shore and 23 at Blacktown.
“The current practice is to discharge mothers and babies ASAP,” Brett told Nine TV’s Today Show.
“But where there is a shortage of midwives in the post-natal area there is a risk that mothers are not getting the assistance they need to establish breastfeeding properly.
“That can lead to complications and the need to return to hospital if babies are dehydrated or unwell.”
Brett was asked to respond to claims by NSW Health that, “There is not a significant shortage of midwives in NSW. However, there are workforce challenges in some districts associated with population growth.”
He replied: “What we go on is the real-life experience of midwives on the ground and they tell us loud and clear there is not enough midwifery time to deliver the care those mothers and babies need. And that they are constantly being asked to work additional shifts and double shifts.”
“Unfortunately, midwives are also choosing to reduce their hours as a result of the workload pressures they are under.
“The more pressure that is put on midwives the more likely they are to seek alternatives to being under that enormous pressure.
“We’re also concerned where those vacancies are occurring they are replaced by non-midwives.”
He said postnatal staff had only a short time to establish that a mother could successfully breastfeed and be able to go home safely and ensure her baby was well cared for.
He was asked: “What is your advice to any new mum who feels she is being forced to leave hospital too early?”
He replied: “She should definitely speak up. Talk to the midwife about her concerns and if the midwife seems under too much pressure then talk to the Midwifery Unit Manager.”
Opposition health spokesman Walt Secord said a lack of resourcing was risking the safety of mothers, babies and staff.
“The Berejiklian government has a clear strategy here: don’t fill positions; push existing staff to breaking point and then claim to be great economic managers – but all the while jeopardising patient safety,” he said.
“Unfortunately, the government has the wrong priorities. They prefer to spend $2.2 billion on stadiums rather than improving patient safety and care for newborns and their mums.”
Breastfeeding rates down, re-admissions up
In a letter to Health Minister Brad Hazzard, Brett Holmes highlighted the problems facing Wollongong Hospital’s maternity service.
“Staff are made to feel that patients must be discharged in 48 hours (the unwritten practice is two nights in hospital) with this early discharge often causing increased readmission rates … requiring phototherapy,” he said.
“All midwives know that jaundice of the newborn takes two to three days to appear, hence the increase in readmissions.”
He said breastfeeding rates had “plummeted” for many reasons.
The main reason appeared to be a lack of time or skills needed to teach new mothers how to breastfeed.
“The best practice guidelines around breastfeeding are nowhere near being met.”
Brett told the minister that the union’s Assistant General Secretary, Judith Kiejda, visited Wollongong’s maternity unit to meet with members.
Judith reported that while “some things have changed for the better, most are only temporary.”
While midwives were being actively recruited, “those that have been ‘holding the fort’ are now leaving once ‘reinforcements’ arrive.”
Brett’s letter included suggestions for improvements at Wollongong’s post-natal ward, birthing unit, antenatal unit, maternity support program, midwifery group practice and early pregnancy assessment service.
For the postnatal ward, he recommended:
- A pool of casual registered midwives be established to ensure that roster vacancies are filled with RMs.
- Replace any absences with ‘like-for-like’ in line with the nurses and midwives award, Clause 53.
- If a baby is born early, anticipate the need for phototherapy and do not enforce the ‘out in 48 hours’ practice.
He said it was incredible that the antenatal unit had no clinical midwifery educator, vacancies due to midwives going on maternity leave were not backfilled and classes were inconsistent due to lack of staff.