New Zealand midwifery model of continuity of carer must be safeguarded

I have been worried by the social media and media coverage of the New Zealand maternity system lately. Some of the dear David’ comments/responses have been uninformed and sensational, yet many are heart rendering pleas from Midwives wanting financial recognition for the work they do. Rightly so! The NZCOM have asked for solidarity and action. Although I now live in Aberdeen Scotland I know the value and preciousness of the model of care in New Zealand – I also remain very much a New Zealand midwife. So pen to paper I wrote the following email to David Clark (health minister) and Jacinda Ardern (prime minister) at the New Zealand government, and Karen Guilliland the CE of the new Zealand College of midwives (NZCOM).

Dear Colleagues in New Zealand,

I applaud the NZCOM rapid response to the social media discussions concerning New Zealand’s excellent midwifery services. Having worked in various countries and regions globally, including 10 years as an LMC rural/remote rural midwife in Northland, and a 15 years in the UK system, I wholly support the midwifery led continuity of carer model in New Zealand. It is by far the most progressive model of delivering midwifery care I have witnessed and experienced anywhere. Working in New Zealand as a rural LMC midwife was the best days of my entire midwifery practice. The relationships I was able to build with women, their families and communities provided much joy to my own practice.

The evidence on optimal maternal satisfaction, safety and positive outcomes with continuity of carer are clear to everyone globally. Many of us working in midwifery practice development, education and research around the world now look to New Zealand for ways to make the system of continuity of carer sustainable, both for the midwife and the communities in which they work. Empirical evidence clearly shows that sustainable LMC ways of working are possible if the payment and support structures are in place. My own New Zealand study (completed in 2015) clearly showed how NZ rural midwives enjoyed what they do yet felt under pressure to work in unacceptable ways – they just need sufficient paid locum support, back up, and funding pathways that do not penalise them; they need to feel supported by an infrastructure that appreciates the valuable work they do in rural communities. The model is not the problem it is the payment structures. Recent evidence shows that LMCs do very well emotionally and enjoy what they do when supported. To consider changing the maternity model of care in New Zealand would be a travesty.

I am now working as a professor of midwifery in Scotland that has had a recent review of all maternity services (Best Start, Scottish Government, 2017). I gave evidence to the policy working group in Scotland on continuity of carer models of midwifery care provision and used the NZ experience as an exemplar. The number one recommendation out of 76 in Scotland’s maternity care reform is: ‘Every woman will have continuity of carer from a primary midwife who will provide the majority of their antenatal, intrapartum and postnatal care…..’. The same recommendation then recommends ‘midwives will normally have a caseload of approximately 35 at any one time’. This recommendation was developed from the evidence and wide consultation with women, families, midwives, obstetricians, neonatologists, managers, researchers and educators from across Scotland. Likewise, a similar review of maternity services from England ‘Better Births’ (2016) recommended continuity of carer for all women based on the evidence and women’s wishes for their care. Currently I am supervising a group of postgraduate research students exploring midwifery continuity of carer implementation in North East Scotland. Many of our senior undergraduate midwives in Scotland are eager to work in continuity of carer practices. In Scotland we are finding and working towards a change that would ensure continuity of carer for all women – something that you in NZ already have.

I hope that the NZ ministry of Health takes heed to the international evidence, women’s wishes and policy direction for maternity services. Currently NZ is shining a light on the journey ahead for many global regions – let them not turn that light off.

Kind regards


Dr Susan Crowther, Professor of Midwifery

Robert Gordon University | Garthdee Road|Aberdeen | AB10 7AQ

T: +44(0)1224 263291    ORCID ID:  0000-0002-4133-2189

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