Rural women missing out on vital pregnancy ultrasounds

Maternity care is supposed to be free and available to every woman - but that isn't the case. 

Senior doctors have told Newshub Nation that funding for maternity care is broken and pregnant women are missing out on ultrasound scans - and Health Minister David Clark has known about it for at least two years.

Lack of access to healthcare for pregnant women can see them miss out on crucial scans, including some that should be offered to every pregnant woman. Going without can have tragic consequences, as Kaitaia midwife Shelley Tweedie told Newshub Nation. 

"The worst outcome you could look at is having a foetal demise, a baby dying. That would be the worst outcome that could happen from a lack of access to ultrasound services. It is absolutely devastating. Nobody would want to go through that."

In Kaitaia's only midwifery clinic, Nara Mau is expecting to give birth in months. Tragically, she lost her last three pregnancies to serious birth defects. This time, the scans show the baby is well. But getting the proof took her far from Kaitaia, where she couldn't get the ultrasound she needed.

"I had an eight-week, a 10-week and a 12-week scan down in Kerikeri, and then we had to travel to Auckland for our 18-week scan. That was the last scan we had to do to get confirmation of a healthy baby," she told Newshub Nation. 

A four-and-a-half-hour drive each way to Auckland for a woman whose pregnancy could've been at risk.

Kaitaia Hospital has one sonographer. Just 14 women can get scans each week. Many wait a whole month to get one. And a key genetic screening at 12 week for disabilities isn't available in the town at all, despite being part of the screening programme offered to all women. 

So expectant mothers face a choice in Kaitaia - travel large distances or miss out on a scan. Kerikeri is the nearest private clinic, 100km down State Highway 1. 

But many live further north than Kaitaia, and Tweedie says for some women it's simply too far.

"For a lot of people actually that's too hard, it's too hard to take a whole day out of my life, maybe time off work, maybe organise childcare, the cost of going there."

The shortage of pregnancy ultrasounds is happening just where it's needed most. Northland's perinatal death rate, babies dying before or just after they're born, is among the worst in the country.

But it isn't just the Far North where access is limited. Other rural areas face the same issues. 

Claire MacDonald, College of Midwives adviser, says even in the big cities there is the issue of added costs. 

"Sometimes women need to go and ask WINZ for additional funds. Sometimes those funds are required to be repaid over time"

Maternity care is supposed to be free but the backlog at hospitals sees women go to private clinics where the Government only funds part of the bill. Surcharges cost up to $60 and for some women, that's too much.

Senior doctors tell Newshub Nation they're concerned funding for pregnant women is in fact being spent elsewhere. DHBs get bulk funding for maternity services - but don't have to report how it's used. There's no way to know if it's going to women or being spent on other things.

Newshub Nation has obtained this letter from a senior doctor in 2018, sent to the Prime Minister and the Minister of Health.

"DHBs are not required to report maternity ultrasound service provision to the ministry and there is consequently no useful data on whether it is being provided at all. It is unclear where the money is going.

"Essential primary screening scans should be widely available to every pregnant woman and they should be free to NZ residents but this is not the case."

Health Minister David Clark wrote a reply two months later in May 2018.

"This is an issue that needs more attention and I am aware that the current arrangement is problematic," he said. 

 "One of my priorities as Minister of Health is to improve equity of health outcomes, especially for Māori and Pacific peoples." 

Dr Clark declined an interview with Newsub Nation. But since writing that letter, little's changed. MacDonald says change is long overdue. 

"The College of Midwives has been raising this issue for years and we still haven't seen it resolved. We need to value women, and we need to value babies, and we need to value whanau."

Back in Kaitaia, Tweedie is growing tired of waiting.

"If we are worried about a mum and a baby and it's keeping us awake at night, and maybe they can't access a scan, well, what are we gonna do? Are we gonna put them in our car and drive them down to the radiologist ourselves? I don't know. It's hard."

She's surveyed the women in her district, and found 45 percent had to leave Kaitaia to get the scans they needed. 

And her plea for improvement to the Northland District Health board saw them get just two more scans each week. The DHB says it's committed to ultrasounds in Kaitaia, but there is a shortage of staff and equipment.

Both are "being pursued" but Tweedie says it isn't enough. 

"We can stand up, we can shout and say this is not fair but no one's doing anything about it, no one is making those changes, and it's always delayed and delayed and delayed. And it's just not right and it needs to change and it's been going on for too long."

Too long, too expensive and too far to travel for care that should be accessible and free.