Photo: RNZ
Nearly 5000 birth injury claims have been accepted by the Accident Compensation Corporation (ACC) since cover was expanded nearly a year ago.
It's a huge leap from just 295 accepted claims in the 12 months before the changes came into force on 1 October 2022. But it's a far cry from the 28,000 birthing parents the new scheme was estimated to help each year.
The move to expand ACC cover for birth injuries was sparked by an RNZ investigation highlighting the difficulties women had in getting treatment.
At the time, birth injuries were only covered by ACC if they were a result of a treatment injury, leaving thousands facing long waits in the public system to get help.
The ACC Amendment Bill (Maternal Birth Injury and Other Matters) changed the criteria so nearly all birth injuries are now covered. Initially, the change was expected to help up to 18,000 birthing parents a year. The estimate was later increased to between 27,000 and 28,000.
But nearly 11 months into the new regime, just 4906 claims have been accepted. Almost all claims (96 percent) were accepted, well up on the 30 percent acceptance rate prior to October 2022.
Why was the estimate so wrong?
ACC said it was not sure why there was such a big gap between actual and estimated claims.
"The demand for maternal birthing injuries cover was modelled using estimates based on a breadth of research from New Zealand and overseas," ACC acting chief clinical officer Dr Dilky Rasiah said in a statement.
"Our estimates were based on literature review rates and, particularly for the injuries that were not tears, these were often highly uncertain in terms of percentages. For example, the literature review gave a range of 0.01 to 9% for a ruptured uterus. We used rates that tried to balance the uncertainty."
ACC was developing a digital platform to make it easier for midwives working outside of hospital settings to lodge claims, which should be up and running next year.
Educating midwives about birth injury claims was also a "priority", Rasiah said.
"We had always anticipated that it would take some time for claims numbers to grow. We didn't set firm expectations for how many claims we would receive in the first year."
New Zealand College of Midwives chief executive Allison Eddy said ACC's estimates may have been too high.
"We have approximately 60,000 women giving birth each year, so ACC is predicting that almost half of births would have an injury that needed treatment. That did seem quite a generous estimate as most birth injuries are mild or moderate and heal spontaneously without additional treatment."
While the expanded coverage was a fantastic step, the system still needed "bedding in". Inconsistency in lodging claims may explain lower than expected numbers, she said.
Some hospitals had automatic systems for filing claims, while midwives working in the community had to file paper claims, Eddy said.
ACC was developing a digital platform to make it easier for midwives working outside of hospital settings to lodge claims, which should be up and running next year, Rasiah said.
Educating midwives about birth injury claims was also a "priority".
"We had always anticipated that it would take some time for claims numbers to grow. We didn't set firm expectations for how many claims we would receive in the first year."
Birth injuries could take months or years to show up, said Birth Trauma Aotearoa founder Kate Hicks.
"Sadly, women and birthing parents often still come across dismissal, gaslighting and misdiagnosis of the pain or discomfort," Hicks said.
"So we really need to ensure that all healthcare practitioners are adequately informed regarding birth injury, and so understand the pathways towards diagnosis and treatment."
Pelvic physiotherapy
While it was good news to see the acceptance rate of claims was "very, very high", Eddy said one of the predominant treatments that women would benefit from was pelvic health physiotherapy. It was not clear the sector would be able to meet that need.
The co-payment ACC physios were entitled to charge could also be a barrier for parents needing help, she said.
Dr Gillian Gibson. Photo: RANZCOG
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists said pelvic physio should be fully funded for birth injuries.
There was a shortage of pelvic physio specialists in the public system and it could cost $50 to $60 dollars to go private, even with an ACC claim, president-elect Gillian Gibson said.
"For some birthing parents that's going to be unaffordable, that may be enough of a barrier," Gibson said.
"RANZCOG would like to see pelvic floor physiotherapy fully funded, so that all women and birthing parents have access to that."
Just over half of accepted claims between October 1, 2022 and August 23, 2023 received medical or hospital treatment at a cost of $1.6m. A further $796,905 had been paid in weekly compensation to parents who were unable to work due to their injuries.