Rachel Peters on when your birth plan doesn’t necessarily go to plan, and what we should be doing about it

Every mother is encouraged to make a birth plan. What are you going to do when you start to feel that tugging in your stomach? Who will be there? What will your support person need to pack? But a birth plan is a bit of a pointless task, because nothing ever goes to plan. In my case, even when I did make decisions, they ran against what the midwives considered best practice, so they may as well not have asked me at all.

“You want to give birth at the hospital with an epidural?! Here’s a little fact sheet to take home. Going to the hospital increases your chances of ending up with a c-section, and an epidural makes it harder to push, it’ll increase your chances of needing the forceps.”

This is not to say that midwives don’t do an incredible job in a system where they are overworked and undervalued. Lately I have been addicted to the show My Māori Midwife and in extreme flights of fancy have allowed myself to wonder what it would be like to perform such important mahi. How incredible it must be to witness the first breath of a newborn baby and to be part of the happiest moment of any parent’s life. But if I am honest with myself, I just have a strong preference for a more clinical approach. The beeping of machines, ultrasound equipment, the knowledge that they have drugs at hand make the hospital maternity ward a comforting place for me. At the risk of being cancelled I am also going to say I would have preferred to have had an obstetrician.

When I was pregnant with my first, in 2016, a study from the University of Otago came out with findings that babies were more at risk with midwife-led births. It was hotly contested, and the researchers themselves noted that it may be the case that midwife-led births could be safer than obstetrician-led births if the system was functioning optimally. Furthermore, it has been found that birth outcomes are inequitable, with Māori, Pasifika and Indian families faring the worst, and those who lived rurally, or had a lack of resources more at risk.

New Zealand is still a safe country to give birth in comparative to other countries, and if you look at quantitative data on birth mortality then you would probably see a rosy picture. But anecdotally, almost every woman I know has some gripe with New Zealand’s maternity system; I am certain that a qualitative review would tell a different story.

A growing number of women are being injured giving birth. At ante-natal classes we were told it’s our office jobs that are doing our pelvises no favours. Or maybe it’s just that our babies are getting bigger. But regardless of why, we need to reduce the harm that labour is causing to our bodies, and part of this is going over the fear of having a c-section – often the safest option.

Irrespective of my midwives’ wishes, I ended up going to the hospital for my labour, because I was 14 days overdue and needed to be induced. Even after 24 hours of oxytocin my body was not performing regular contractions and my midwife sat at the end of my bed saying, “It would be such a shame for a young, healthy lady such as yourself to end up with a c-section.” If I could have mustered the energy I may have yelled “Why is it a shame?”

Last week I read a piece about how ACC has reviewed its policy on perineal tears, no longer covering tears if they are not a result of intervention. I would bet money on a claim that whoever made this new rule has never given birth. After ACC’s recent review of the ‘inconsistencies’ in their approach, the 30 childbirth-related injuries they were expecting each month has reduced to four. It is hard for me to understand what they were thinking here, leaving women with birth injuries and birth trauma to wait for months for care in the public health system.  

After you give birth, you get moved out of the hospital quickly unless you had birth complications. A couple of hours to have a shower and a cup of tea, then off to the ante-natal ward, and you may be out of there before your milk has even come in. When I was calling my midwife for support once I was home, she suggested we spend hundreds of dollars going to a cranial osteopath and driving out to Titirangi to buy some herbal tea which would boost my milk supply. Not everyone in the public health system has the ability to do that, and is it even evidence-based?

Aside from the issues with physical care for our mothers, the New Zealand perinatal system is also not doing a good job looking after the mental health of our parents either. Suicide is the leading cause of maternal death in New Zealand and it particularly affects Māori women. Counselling and financial support needs to be made more readily accessible, especially for our most vulnerable families. Looking after our parents through a highly stressful period of their lives leads to good outcomes for our babies. People pay lip service to giving our children the best possible care for the first 1000 days, but does our current maternity system support that? It’s time to review the state of maternity care in New Zealand, and check in with our parents. Are they getting the support they need?

Rachel Peters is a media and communications researcher and lecturer at Auckland University of Technology.

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