Would-be midwives quitting over costs

"I don't know how much more broken the system can get."

That is the message from a community midwife of over 20 years, battling burnout and calling for urgent support to keep students and improve working conditions.

Midwifery has the greatest shortfall of the healthcare sector - to fill the gaps an extra 300 students need to graduate a year.

But one new graduate has told Checkpoint financial pressure has made the degree unsustainable - over 70 percent of her class had dropped out by the time she graduated.

On her first day, Beth Fisher-Evans said students were told having a job on top of studying would be impossible. She said getting her degree was a constant juggle of classwork on top of placement hours - when a patient could go into labour at any time.

"You've got assignments due in the background that you're trying to get done, and you could be called out any minute. It's a lot - if you have an assignment due in 24 hours and then you get called out and you're at birth for 24 hours, it can be pretty taxing."

That meant a lot of financial pressure, with some of her classmates mothers themselves. It took a lot of budgeting and support from her whanau to make things possible.

"I didn't have like any way to get to the births, so my family had to help me out with buying a car and then on top of that, you know, you're trying to pay for your petrol... you're also having to pay for things like uniforms and then equipment, like stethoscopes."

Fisher-Evans graduated four years ago and now works as a community midwife in the Waikato Te Awamutu area.

Sheryl Wright has been practising as a midwife for over 20 years. She said paying students while they work with an 'earn to learn' model is desperately needed to prevent students dropping out.

"We do it for, for tradespeople, we do it for builders and electricians - why are we not doing it for our healthcare workers?"

When Wright relocated from the Waikato region to the upper Coromandel in 2019, having 11 midwives in the area was deemed "a critical shortage". Now there were just three.

"I was teamed up with another midwife and we worked as a partnership, which is ideally how things work, either in a partnership or a group practice. For the last three years I've been all on my own, with my nearest backup an hour to an hour-and-a-half away."

Community midwives are paid in sections per patient, for the first, second and third trimester, then a birth and post-natal fee.

Wright said being paid in lump sums did not account for things like travel costs, which were based on where the patient lived, not the midwife.

"I go through tonnes of tyres - like, a set of tyres is lucky to last me five months because of the condition of the road, especially in recent years after our cyclones. The price of fuel in our district, you know, is sometimes up to 30 cents a litre more than it is in town."

Working without a partner meant she was required to be available 24/7.

There was government funding available for a second midwife to be called out when she needed a break. But Wright said there was no one to call nearby, and the two other midwives in her area were just as busy.

"I don't know how much more broken the system can get really, and I feel like they're running on the goodwill of those of us that are left."

Violet Clapham, midwifery advisor at the New Zealand College of Midwives, said many midwives were struggling through burnout.

"Sometimes the only choice you're faced with at the end of the day is whether you stay or you go."

New Zealand's midwifery model was unique, with the same midwife taking care of the patient from the start of her pregnancy right through to postnatal care. Clapham said maintaining this level of care was vital, but to keep it up, they needed 1050 more midwives on the ground now.

"That's a really special relationship within healthcare, so it's something that we're really passionate about protecting."

In Health New Zealand's latest health workforce plan which covered last July up to the end of June, it said it would start developing an 'earn as you learn' framework for midwifery.

Clapham said to date no detail had been given, and it was still unclear what funding - if any - had been dedicated to midwifery in this year's Budget.

"It is quite hard to understand how we have a workforce plan that was released in July of 2023 and yet here we are, a year later, and no solutions have come forth."

In a statement, interim chief clinical midwifery officer at Health NZ, Nicole Pihema, said it had recently seen encouraging growth and now employed a record number of midwives - 1117 full-time equivalent (FTE) employed across the motu, an increase of 76 FTE over the last quarter.

"We highly value our midwives and agree with the college that we need to grow this workforce."

Pihema said Health NZ had been working with midwifery schools to open up enrolments and was supporting universities to develop a graduate entry pathway for people to retrain as midwives.

Since March, funding had been available for midwives to return to practice.

New midwives can access more than $3000 every year for five years once they graduate as part of the government's Voluntary Bonding Scheme to attract more people to the profession.