Jon, I think your prejudices may be showing.

Jon Wilcox wrote:

That is the nature of the general arrangement and Dr-Mother bond.
Midwives here are not trained to a high level (in the vast majority)
have no desire and are unable to perform common obstetric interventions
such as pudendals, Wrigleys, Neville Barnes, and even episiotomies in
many cases. 

Midwife training in NZ is of a high standard (three years exclusive education for midwifery - in educational institutes combined with practical training in hospital and community).  They have much more training in maternity care than do our medical students and arguably more practical experience in managing normal birth than many doctors who take the Diploma in Obstetrics.  Certainly their training is not focused on carrying out "obstetric interventions" such as you list but I don't accept that these are the hallmarks of good preparation for the job of providing the broad range of maternity services to women expecting normal births.

The Government of course would like to change that, but that
is not what our mothers want. 

Well, since 1990 women in NZ have been able to choose to be cared for by a midwife without the involvement of a doctor.  The number so choosing has steadily increased as the number of midwives working independently has increased.  Last year 40% of the birth fees went to midwives compared to 32% the previous year.   Of course a fair proportion of these were in situations where both a doctor and a midwife were involved yet there are certainly increasing numbers of women choosing midwife only care.  And the results appear to be just as good - decreasing overall stillbirth and early neonatal death rates, inproving breast-feeding rates, and low levels of intervention in midwifery care.  Not surprising if you look at the evidence from an increasing number of randomised trials overseas.

Unfortunately our Government (Ministry of
Health) is not brave enough to actually ask the mothers (in properly
designed surveys) which is why our maternity services at present are in
a total state of disarray coming up the the elections.
The Government honestly thinks they know what our mothers want, but they
have seriously misjudged them and their GP-obstetric practitioners.

I grant you that surveys of this sort haven't been carried out in NZ - but, as I say, there are increasing numbers of women who are choosing midwives and they have good outcomes and high levels of satisfaction.  Yet I strongly hope that GPs keep their involvement in obstetrics - for the sort of reasons that have been outlined in the recent article in the British Journal of GP.  I believe that for most women there is a place for a partnership between midwife and doctor in offering care - and one way or another I think that's what we'll see develop here out of the 'disarray'.


Dr John Marwick, FRNZCGP
Ministry of Health,Wellington






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