Funding inequities

In New Zealand Lead Maternity Carer (LMC) midwives may care for a woman from pre-conception through to six weeks post-natally. This service is funded by the government. A request for epidural anaesthesia during labour calls for an LMC to recommend a consultation with a specialist. The transfer guidelines suggest that the LMC can reasonably expect to continue providing care until the facility has a core (hospital-based) midwife available to take over. The LMC may also choose to stay with the woman in a support role following transfer of clinical responsibility. So how do case-loading midwives feel about providing ongoing care when a woman has an epidural in labour?

This study explored LMC midwives’ perceptions and experiences in relation to transfer of midwifery care for women whose labour choices or needs include epidural anaesthesia. Two focus groups were conducted; one with a group practice who provide continual labour care for women with an epidural, and the other with a group practice where the midwives transfer midwifery care for epidural to the core midwives at the facility. Midwives in both groups felt passionately about their well-considered philosophy and practice decisions. They clearly articulated their objectives for healthy inter-professional relationships in the facility setting.

The midwives who chose to provide epidural care, expressed a growing sense of disillusionment with the perceived inequity in payment for providing what they saw as secondary care as a primary-funded midwife, and therefore - in effect - subsiding the District Health Board (DHB) services by providing epidural care in the interests of continuity with the woman. Midwives who had chosen not to provide epidural care articulated their joy in being with women having a normal childbirth experience and their ways of keeping a safe space for women to birth. 

Both groups intimated that payment issues and inequity have created disharmony and tensions regarding this aspect of midwifery care provision, by challenging the philosophy of continuity and questioning some basic concepts about what it means to be a case-loading midwife. There are serious implications for sustainability for practice when midwives feel undervalued for the work they do. The current system only works because dedicated midwives go above and beyond the call of duty to provide excellent care, bridging the structural inequalities created by an outdated funding system.  

Bronwyn's research was supervised by Suzanne Miller and Karen Wakelin. Read Bronwyn's full thesis here.