The Women’s Rights Party has major concerns about how an extra postnatal day is realistically going to be delivered in a climate of health cuts, primary facility shortages, and a midwifery staffing crisis. We would be concerned if this Bill was seen as solving the issues related to quality support and care in the immediate postnatal period after childbirth. A whole of maternity focus is required to ensure increased numbers of primary maternity units, stronger clinically focused/science-based education within the universities/polytechnics teaching midwifery and medicine, and recruitment and retention of midwives.

The Women’s Rights Party welcomes the opportunity to provide a submission on the Pae Ora (Healthy Futures) (3 Day Postnatal Stay) Amendment Bill. The Women’s Rights Party is a registered political party representing around 800 members, and focused on issues that directly impact women, girls, and children.

We strongly support all initiatives to improve the maternity system for pregnant women and mothers which make a positive difference to postnatal care. The transition to motherhood is a significant time in a woman’s life and a quality service that fosters a positive start in the early days after childbirth is critically important for the mother and her baby.

Our feedback is below:

1a: The New Zealand maternity system has developed into an unusual and less than satisfactory service that requires the transfer of new mothers and babies from tertiary or secondary hospitals to primary maternity units within a few hours after birth in many regions. This early transfer after birth is disruptive to the beginning of the mother-baby relationship and it also causes disruption of the breastfeeding process.

Women who are transferred too early may suffer a postpartum haemorrhage (PPH) or they may have had a Caesarean section and require additional secondary or tertiary level post-surgery care (i.e. in the maternity wards of a hospital).

If care was women-centred, mothers should be able to stay in hospital for as long as their condition requires. There needs to be some recognition that not all women will follow a standard birthing pattern. Some will have had traumatic births and many these days will have had major abdominal surgery. Mandating only 72 hours may mean sick women will be disadvantaged if this is applied to all women.

The current situation appears in some cases to be related to the demand for birthing spaces in the hospitals and the need for women to move through this area to free a space for another labouring woman.

1b. The solution may be to provide more opportunities for mothers to labour and birth in primary maternity units, preferably with those units publicly provided through Health
New Zealand | Te Whatu Ora, rather than as privately-owned businesses contracted to Health NZ for services provided. The contracting model has led to inequalities in funding actual costs (including staffing costs) and a decrease in provision of birthing opportunities. The closure of primary birthing units in some regions is concerning. For example, there are currently no primary birthing options in the former Auckland DHB area with Auckland Birthcare now offering postnatal services only.

Birthing in a hospital is linked to an increase in birth interventions. This means that more women may need to remain in the hospital which puts a strain on bed availability and increases acuity for already stretched staff numbers on postnatal wards, where short staffing situations and reduced numbers of midwives are available. The result has been a decline in the specialist services provided by midwives as nurses have replaced midwives on many postnatal wards, especially in large maternity hospitals such as Middlemore in South Auckland.

The Government needs to consider the fact that the majority of women can birth in primary birthing units, thereby reducing birth interventions and supporting a good start to motherhood. This issue needs to be addressed in any discussion about postnatal care.

1c: The extra pressure, particularly on the five large tertiary hospitals, may make the extra postnatal day stay difficult and if staff numbers are lower than desirable, a mother may not receive the support she needs even if she stays for an extra day. One-to-one care provided by a Lead Maternity Carer midwife (LMC) may be more supportive in some situations than remaining on a stretched postnatal ward experiencing staffing issues.

1d: Bed availability and staffing shortages need to be urgently addressed – this includes recruitment and retention of midwives.

2a: Midwives already provide up-to-date information to women and will incorporate this new legal requirement into their practice. However, we do have to question why this aspect of health care requires a legal mandate rather than being a policy requirement of midwives and the maternity facilities.

2b: Some consideration of situations when the extra day is not achievable needs to be discussed further. For example – if there is no bed available and a request cannot be accommodated, what services will be available to meet maternal requests?

What additional support may be available to mothers who want to leave a facility early for various reasons, such as being unable to sleep or rest in the hospital, being unable to get the support they need due to staffing issues, and wishing to be home with their partners and other children? For example, some DHBs used to provide nappy service for a month for those mothers accessing early discharge. In this day and age, how about vouchers for disposable nappies, or provision of home-delivered, healthy pre-cooked meals?

Home help or district nursing services in the absence of rural LMC availability was also offered in the past for women with high medical dependency, for example, stoma cares, post sepsis, post PPH (with an increasing incidence these days in the presence of inductions and surgery).

3a: Achieving the required number of bed spaces and nationwide access to primary birthing units will take some time. Health NZ will also need to immediately address safe staffing, availability of beds, acuity, midwife: woman/baby ratios and midwife recruitment and retention.

1. We consider it necessary to point out that midwifery care in New Zealand is unique as it is based on a continuity of care midwifery model which means women get to know their own midwife in pregnancy. This midwife continues care through labour and birth and then provides postnatal care up to six weeks following the birth.

2. There has been minimal recognition previously of the importance of postnatal support in terms of the transition to motherhood and the need for quality care in the childbirth recovery period to support bonding and attachment and a good start to breastfeeding. For example, parenting education is woefully inadequate currently. Knowledge, expectation management and education can prevent a
multitude of postnatal complexities/anxieties. Ante-natal courses also enable the formation of support groups of similar parents that help the transition to parenting. In this regard we note the announcement of Parents Centre that this
organisation will no longer be able to provide ante-natal courses in light of the decision by the Board to wind down its operations as of 31 December 2024.¹ Parents Centre was NZ’s largest provider of antenatal education over more than
50 years and had played a major role in advocating for more natural births.

3. Midwifery care is provided initially in maternity facilities by core (employed) midwives and care is then continued in the community after leaving a maternity facility by LMCs, who are usually self-employed, for up to six weeks after the birth. This system is under strain due to a failure of successive Governments to deliver fair remuneration for LMCs. As a result, it can be difficult for pregnant women to find an LMC in some areas.

4. For those women who do not have a lead maternity carer midwife, a home postnatal midwifery service is still available, often provided by Health NZ community midwifery teams.

5. While we support the 72-hour stay, we have some concerns that understaffed postnatal wards will not achieve the quality of postnatal care this Bill aims to promote. The Bill also presents a simplistic ‘solution’ to a serious and complex
problem. One more day in a tertiary maternity facility is not a panacea for the stresses experienced by some women after birth. Recognition of social issues that impact mothering and parenting and how all parents and babies can have a good start that supports health and wellbeing represents an urgent discussion. There are other initiatives that would improve the postnatal care and experiences of women as well as an extra day stay.

6. Maternal heath inequities need to be addressed along with the experiences of new mothers in maternity facilities. Ensuring mothers experience equitable and culturally safe health outcomes is paramount.

7. Clinical needs will still need to be privileged in terms of health and safety and while lack of bed spaces may cause some stress for women who had expected to be able to stay longer, we should aim to avoid the idea that going home somehow represents an inferior form of postnatal care. This is usually not the case as the large majority of women have a known midwife providing their postnatal home care for up to six weeks after the birth.

The Women’s Rights Party supports the intent of this Bill to increase clinical care for post partum women and newborns, but we have major concerns about how this extra postnatal day is realistically going to be delivered in a climate of health cuts, primary facility shortages and a midwifery staffing crisis. We would be concerned if this Bill was seen as solving the issues related to quality support and care in the immediate postnatal period after childbirth.

A whole of maternity focus is required to ensure increased numbers of primary units, stronger clinically focused/science-based education within the universities/polytechnics
teaching midwifery and medicine, and recruitment and retention of midwives.

Thank you for the opportunity to make this submission. We would like to present an oral submission.