Dear Jacinda

Rt Honourable Jacinda Ardern

Parliament House

Wellington 

cc: Waikato District Health Board

      Pembroke Street

      Hamilton 

5th December 2019

To Whom it May Concern,

Something needs to change…

You’ve been through the pain. You know how it feels to give birth. You know how you feel both physically and emotionally. But do you know how it feels to go through that pain and walk out of the hospital with nothing but a box, instead of your baby in a car seat?

I’m not angry, I’m not on the blame train, i’m not clouded by my emotions, but I am determined and now very passionate about seeing better support systems (both structurally and emotionally) put in place for mothers with preterm babies in Level 3 Neonatal Intensive Care Units (NICU) around New Zealand.

Currently, New Zealand has 6 Level 3 NICU units to cater for the 10% of babies born prematurely every year and those babies born that need extensive medical care;

1) Auckland City Hospital 

2) Middlemore Hospital

3) Waikato Hospital

4) Wellington Hospital

5) Christchurch Womens Hospital

6) Dunedin Hospital

You just need to put the word ‘NICU’ into Google to find a Stuff article about overcrowding in Hospitals. In 2018, Meier and Duff wrote on Stuff;

“A Stuff investigation has found Neonatal Intensive Care Units (NICU) are struggling with overcrowding, with at least three units dealing with more babies than their capacity allowed for most of last year.”

Upon interviewing a Mother of twins , Meier and Duff continue to say, “Her babies received “wonderful care” but the busy unit made it hard for her and her husband to bond with the twins, who were frequently kept in different rooms for space reasons.”

In my view, the most important aspect to a newborn’s life is the connection with the Mother (or if this isn’t possible, the next in line primary caregiver). Skin to skin contact has been mentioned as being one of the most important aspects of bonding for a Mother and baby. From the perspective of someone who has been able to hold one of her babies straight to her chest, directly after birth, and after a subsequent birth have her baby taken swiftly away from her in order to save its life… I am concerned about the care of this delicate, emotional stage of Motherhood that lies in the hands of the 6 NICU units

No birth is ever easy. When I gave birth to my first child at full term, I held my baby to my chest straight after she was born and experienced something ultimately life changing. Something I had grown inside me, a living being, was now squirming in our world, on my chest. I then had the luxury of spending 2 days in a post birth centre, where i was supported by both nurses and midwives, with all meals provided and my own bathroom and double bed for my partner to stay.

In stark contrast, with my second child, I delivered at 24.4 weeks and for the short period of time that my baby was in NICU, I too can admit that my baby received the most “wonderful care”. I come from a family line of doctors and nurses and I can agree that the medical practice from Waikato Hospital was absolutely ‘on point’ for a preterm baby. The medical staff in Delivery and NICU did everything they could for him. The reality is, that the nurses and our hospital have become very good at caring for pre term babies but our hospitals have become out dated and Mothers aren’t getting the adequate care or support they need during such a vulnerable time frame.

As my baby was downstairs in NICU, I was shipped up to ‘E2’ (two floors above the NICU unit). I was put in a shared room with someone else, with no room for even the idea to be voiced of being able to share this fragile time with my husband. I was so very alone from the beginning of a nightmare no mother ever wants to imagine being her reality.

Midwives play a seriously critical part in a Mother’s life during pregnancy but especially after she gives birth. They ride with you as you recover physically from major body trauma and they support you emotionally as you navigate a new life where you as a person are no longer the centre of your world. 

During the delivery and birth and aftermath of my second child, I was lucky and fortunate to have possibly the best Midwifery care possible. She listened to me with care, compassion and practicality during my pregnancy, as if I was her own daughter. She jumped at every chance to support me at any hour of the day or night, with no suggestion that she might have other patients or places to be or even a family of her own. 

But what about those Mothers that aren’t lucky enough to have such delicate care flow around them after such a traumatic event? What does our Hospital system provide to help support these women and their families before they leave the hospital with that empty box? From my recent experience, I don’t think that Waikato Hospital had any direct care plans in place to provide myself and my husband the support we needed to walk through this event together. We weren’t able to be together comfortably, there were no counselling professionals to talk us through how to care for each other and no one prepared us for how to go about leaving the hospital with crushed expectations. This is in no way a criticism of Waikato Hospital, but more a cry for discussion and plans for some structural development to occur as i don’t believe that Waikato Hospital currently has the adequate infrastructure in place to be able to accommodate such care.

Nicola Austin states the following in her article; “The New Zealand Consensus Statement of the Care of Mother and Baby(ies) at Periviable Gestations”

“Looking at the outcomes for babies born at the 24 weeks gestations, out of the 100 mother/baby pairs:

6 parents decided on supportive care/palliative care

94 decided on active treatment – of these, resuscitation at birth was unsuccessful in only a few

92 were admitted to a NICU unit

64 babies survived to go home which is two thirds of those admitted

For babies born at the 23 weeks’ gestation out of the 100 mother/baby pairs

27 parents decided on supportive care / palliative care

Unfortunately 1 in 10 where active treatment was commenced did not survive due to the stress of labour or unsuccessful resuscitation

62 were admitted to a NICU

27 babies at 23 weeks survived to go home which was half of those admitted”

Ultimately, from this study, my first and last thought is; Out of the 200 mothers, what emotional support by a professional was given at incremental stages throughout the process of medical care? How were they supported both in a structural setting and emotionally?

So, my questions to you, Rt Honourable Jacinda Ardern, the Ministry of Health and the Waikato District Health Board are;

1) Where is the physical structure in our Level 3 NICU Hospitals that supports a preterm baby and their mother/family relationship in the narrow window directly after and following birth ?

2) Where is the counselling support in the hospitals to support the Mother and the Father so they subsequently know how to i) support each other and themselves through the trauma of a premature birth, ii) support each other and themselves through the trauma of a premature death and iii) the reality of walking out of a hospital with a box instead of a car seat

I believe that the Ministry of Health and the 6 DHBs who offer Level 3 NICU care need to provide more adequate and suitable accommodation for parents of premature babies along with direct emotional support to provide a support net for the Mother’s wellbeing in the most crucial time after birth.

No one can prepare a mother for a premature birth and no one can prepare a mother for a baby’s premature death, but I believe our Hospitals should provide the best holistic care possible to support this treacherous journey which is foiced upon Mothers suddenly and involuntarily .

I look forward to hearing from you and hearing what you think about the support required for our DHBs, so we can better support the Mothers with pre term babies.

Yours Sincerely,

Merryn Lane

Mother, daughter, wife and advocate for better care for Mothers, but especially those with pre term babies.

References:

Austin, N. (2019). The New Zealand Consensus Statement of the Care of Mother and Baby(ies) at Periviable Gestations.

Meier, C, Duff,M. (2018). Hospital overcrowding puts most vulnerable babies at risk. Retrieved from https://www.stuff.co.nz/national/health/102252171/hospital-overcrowding-puts-most-vulnerable-babies-at-risk?fbclid=IwAR3SF171060fhYnQ8hOY-ZOYvL-OvKPKyF8Jr5E0X5RN2SOwXviAKmfD1J8

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