Many of the state’s badly understaffed midwifery units are using unlicensed workers to fill gaps in rosters.

The NSW Nurses and Midwives’ Association has warned of “poor to tragic outcomes” if hospitals continue to fill midwifery vacancies with unlicensed staff.

NSWNMA General Secretary Brett Holmes has told the NSW Health Minister, Brad Hazzard, that the staff skill mix in midwifery units is “poor to dangerous” with registered midwives being replaced by Bachelor of Midwifery students, RNs without midwifery training, AiNs and assistants in midwifery (AiMs).

“Maternity services cannot continue to utilise unlicensed workers …to fill vacancies and be assigned full patient loads,” he wrote.

“This critical situation must be addressed urgently as the current situation will surely guarantee poor to tragic outcomes and cannot be sustained.”

Brett said significant roster shortages existed in maternity services at Blacktown, Campbelltown, Fairfield, John Hunter, Nepean, Westmead and Wollongong hospitals, with Wollongong probably the worst.

He said several factors were to blame.

An increase in high-risk births had led to a cot shortage in special care nurseries and forced special care babies to be placed in postnatal wards with their mothers.

This had placed more stress on staff and some-times resulted in an AiM or RN caring for babies with postnatal issues.

Misuse of BirthRate Plus

Some local health districts were misusing the midwifery staffing mechanism, Birthrate Plus, by using exempt categories of midwives to take patient loads and using unlicensed workers to plug staffing gaps.

Postnatal inpatient units everywhere are understaffed because they were not properly considered when Birthrate Plus was adapted from the UK model.

In addition, new regulations covering foreign midwives had resulted in most LHDs deciding not to recruit overseas.

“Some LHDs have been very proactive and have incentives in place to recruit midwives … However, most LHDs do not consider this option due to budget restrictions.

“Before the ministry devolved responsibility to the LHDs, the implementation of Birthrate Plus was working and we believe it is a tool that if implemented properly, results in an adequately staffed maternity unit.”

Brett said the ministry should have a closer relationship with the LHDs on maternity services to ensure that all women, regardless of their postcode, have access to quality maternity care.

In reply, the Health Minister conceded that some services, mostly in western and south-western Sydney, had “workforce challenges associated with increasing levels of activity and acuity.”