Women are giving birth in emergency departments and new mothers are prematurely discharging themselves from hospital, as a worsening shortage of midwives hampers access to maternity ward beds.
Labour inductions are being delayed each day at major Melbourne hospitals, along with routine pregnancy check-ups, amid warnings that legislated midwife ratios – one midwife for every four patients – are not being met.
Jesse Maher was hoping to have a water birth, with dim lights and soft music.CREDIT:SCOTT MCNAUGHTON
“It’s like ambulance ramping – the hospital can’t actually move [the mothers],” said Liz Wilkes, the head of private midwife service My Midwives.
Wilkes said several of her clients had been forced to give birth in emergency departments as if they were “car crash” victims, while others were being prematurely “shunted out the door”.
“Mothers are discharging themselves from the birth suite because they’re going, ‘Oh well, we haven’t actually got a bed to go to on the maternity ward, so we’ll just go home.’”
Victoria has 9842 midwives registered with the Nursing and Midwifery Board of Australia, which is only 624 more than in 2012. Nationally, there are only 981 more midwives than a decade ago.
The state’s midwife shortages have been exacerbated by the pandemic, with one in five midwives estimated to have left the profession during the pandemic, while about 1600 to 1900 healthcare workers, mostly nurses or midwives, are furloughed each day across the state.
Obstetrician Dr Nisha Khot estimates about 20 per cent of maternity staff have left hospital wards over the course of the pandemic, which has had an impact on bed capacity.
Paul Gilbert, Victorian assistant secretary of the Australian Nursing and Midwifery Federation, said the pandemic had made a bad situation worse.
“Pandemic fatigue has stretched the workforce beyond anything that has come before,” he said.
The union warns it is impossible to run services as usual, with one major metropolitan hospital struggling to fill 15 full-time equivalent roles on its roster.
Jesse Maher envisioned a water birth at hospital, with mood lighting and music, but a lack of maternity beds at the Northern Hospital in Epping meant her daughter, Edith, was born in the COVID-19 section of the emergency ward.
“I felt self-conscious,” she said of the birth 11 months ago. “Because you’re having a baby, it’s not quiet and ... there was just a curtain between me and everything else.”
Instead of spending time with her baby after the birth and focusing on breastfeeding and staying calm, she was taken in a wheelchair to a birthing suite clad in blood-soaked garments.
“I was in shock,” she said. “I had to push myself to feed her because there was a part of me that just wanted to lie down and ignore everything. I was just checking out because it was so stressful.”
Katherine Navarria’s induction was delayed due to overcrowding in her hospital’s maternity ward before she gave birth to daughter, Florence.CREDIT:PAUL JEFFERS
Kellie Wilton, the principal midwifery officer at the Australian College of Midwives, said postnatal wards had become the “pressure point” in maternity services, with hospitals often diverting midwives to birthing suites to fill gaps and deliver babies.
Midwife shortages are not a new or local problem. TheWorld Health Organisation has warnedof a shortage of 900,000 midwives, but the impacts of the pandemic – especially the inability to hire skilled midwives from overseas – makes it “really problematic”, Wilton said.
Gilbert said the workforce had been “depleted” by the pandemic. Part-time midwives are reducing their hours to manage burnout and fatigue, while many are either furloughed or on sick leave to care for COVID-positive children. Some hospitals are unable to staff ratios on all shifts and rely on a registered nurse or student midwife to meet the legislated targets.
Khot, who is a board director of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said she received daily notifications from locum agencies looking to fill gaps across the state, especially in regional areas. “Everyone is struggling,” Khot said.
“If there’s a group of women who need an induction or caesarean within a certain timeframe, that timeframe needs to be pushed out because we don’t have the staff to do it safely,” Khot said. “And the induction may not happen tomorrow but in the next few days.”
Katherine Navarria, who gave birth at the Northern Hospital four weeks ago, said her induction was delayed because of overcrowding, though the problem there had become so routine that she was prepared for the wait.
“I was told that it was super-busy that week,” she said. “We just went in thinking it will be delayed and, luckily, we did sort of plan for the worst-case scenario, and it was OK for me because I had that mindset.
“You’ve got to mentally prepare yourself because labour is such a big unknown thing, so when another unknown is thrown in there it can be really overwhelming.”
A government spokesman said a $23 million funding injection would make it possible for public health services to support additional postgraduate midwifery employment, and boost maternity and newborn service capacity in the fast-growing west and south-east.
Of that, $13 million was meant to fund additional midwives to respond to the mid-2021 baby boom in Melbourne, but many metropolitan health services have been unable to spend the funding because of the midwife shortage.
Northern Hospital did not respond toThe Ageby deadline.
https://www.theage.com.au/national/victoria/it-s-like-hospital-ramping-midwife-shortage-puts-strain-on-maternity-wards-20220525-p5aobg.html
