The mother of a profoundly disabled child has questioned New Zealand's maternity care system following a new report showing midwife-led births have an increased risk of adverse outcomes.
Anna Francis gave birth to her son Alex in Christchurch 11 years ago in a midwife-led pregnancy.
Alex was born 13 days overdue and was not expected to survive at all after a complicated birth saw him unable to breathe.
Ms Francis had it confirmed when her son was three years old by experts that she received substandard midwifery care and her son's injury was preventable.
"Looking back now, understanding what happened, it really has identified problems in the system, and we're not an isolated case." Ms Francis told Newshub.
"I think that there are issues that need to be looked at a lot more, in depth, and more studies need to be done."
New Zealand has had a midwife-led model of maternity care since 1990, and now a new study released by Otago University has found adverse events in births are significantly lower when led by doctors or obstetricians rather than by midwives.
The lead author of the study, Ellie Wernham, told Newshub: "There's never been a study looking at the relationship between maternity care system and adverse outcomes in New Zealand. It was really about creating that first evidence base."
"Our main findings were an increased risk of all of the conditions that related to oxygen deprivation around the time of delivery for midwife-led deliveries, and the differences between the groups ranged between about 20 and 55 percent lower risk for the medically-led births," Ms Wernham said.
Midwives make up the vast majority of carers helping Kiwi women to give birth, over ninety percent, and the study could cause plenty of debate.
Many in the health industry claim midwives are under staffed and under-funded, but also argue obstetricians are far more likely to medically intervene in births when it's sometimes deemed unnecessary.
So who should Kiwi mums and their families put their trust in?
In some cases, they have no choice.
Karen Guilliland, Chief Executive of the New Zealand College of Midwives, told Newshub: "Comparing women who choose an obstetrician, who invariably are able to afford a private obstetrician with all the rest of New Zealand women isn't really a good comparison. It gives you the wrong impression."
Ms Guilliland said she saw some serious flaws in the newly released research: "The limitation of the study is that there's a lot of things that we don't know about the women and the care givers that are providing the care. For instance, we don't know if the woman live rurally or urbanely, you don't know if she was healthy in the first place when she came into the maternity system. You don't know whether she's educated, you don't know where she lives, the state of her housing, you don't know the state of her general health, her lifestyle."
Ms Francis says her experience with her midwife, whom she had used for her previous birth, was very good leading up to Alex's birth, but told Newshub: "Things just didn't end as they should, monitoring wasn't done properly, and it was quite some years before I actually understood how that all happened."
And she has sympathy for the country's midwives, saying they too are at risk from working in the current system.
"Given what's happened to us and many other families I now know, relying on a self-employed lead maternity carer with full autonomy makes me feel nervous. Most are amazing but the ones that aren't put the profession in a bad light, " Ms Francis said.
"Every system can be improved, and when this system goes wrong, it's devastating.
"It's hard to put into words what it’s like. Words that come to mind are relentless, exhausting and heartbreaking. We carry a deep, deep sadness and always wonder what would've, could've and should've been. Alex is so precious to us and we adore him but the sadness and grief is never far away.
"It's like having a newborn, forever, it's a heavy weight to carry." she told Newshub.
Ms Guilliland does want greater funding for New Zealand's maternity services, saying: "The hospitals that take referrals from midwives are grossly understaffed, in some places there is no obstetrician to refer to. Under those conditions it is women and babies who suffer. The debate shouldn't be about who the caregiver is, the debate should be how we are not funding our maternity system in a way that all women have the same access to an obstetrician as the private sector women."
She added: "It should not rely on if you're rich or poor."
And money, or the lack of, for New Zealand's maternity services could yet become an election issue next year.
In 2015 the College of Midwives sued the government over pay discrimination, lodging New Zealand's largest equal pay challenge.
Self-employed midwives work long hours for what is essentially a fixed fee per patient.
In some cases, they earned just ten dollars an hour.
That would appear small change for those charged with the birth of the next generation of Kiwi babies.
Newshub.
