DHB Responsible For Napier Maternity Crisis

District Health Board Responsible For Napier Maternity Crisis

Napier’s birthing provisions are appalling for a city of over 55,000 people. The problems with the service lie fair and square with the District Health Board.

The ludicrous provision of just three maternity beds was always set up to fail. The original intention announced to Napier people was that there should be a birthing unit of ten beds. The DHB’s predecessor cut that to six. Then when Wellesley Road opened, there were only three, leaving the unit lacking the necessary critical mass.

Three beds are, and always were, quite obviously uneconomic. The number is also so small that Napier women have not been able to book into the unit with confidence that when their time comes, they will be able to use it.

The DHB was told loud and clear in the 2001 Hardacre Report, a report which it itself commissioned, that the Napier low risk birth facility was entirely safe and "should be expanded to ensure that women who currently request births and postnatal stays are able to access the facility".

The Hardacre Report also urged that "The low risk facility should be publicised and promoted in both Napier and Hastings [as] an alternative birth location".

But the DHB has failed either to expand or to publicise the unit. No wonder the unit is now in trouble. The solution is not to make threats of closure but to put the Hardacre Report recommendations into effect.

Releasing these comments in the wake of "Use maternity unit or lose it" remarks recently published, Dr Robin Gwynn said today that his research had failed to uncover any other city of Napier’s size in the whole of the old British Empire with such poor birthing provision. "What sort of message does that send about our city and our health services?", he asked. "The Napier situation is scandalous. The DHB needs to act urgently on the Hardacre Report which it has had in its hands gathering dust for over three years".

The Report, Maternity Project 2000, was produced for Healthcare Hawke’s Bay by Alison Hardacre as an independent project leader in 2001. It aimed to assess women’s satisfaction with Healthcare Hawke’s Bay maternity services, to "determine what women and healthcare professionals believe is the best structure and facility to support safe, quality, efficient birthing and postnatal care", to assess innovative models and make recommendations. It surveyed all Napier women who had delivered at either Hastings or Napier over a fifteen month period.

The Report found that

There was a serious lack of knowledge about the Napier low-risk facility (pp.19,24,27).

Satisfaction with their postnatal care at Napier was extremely high. Holistic care and support for the whole family/whanau was seen as central to the success of the Napier facility. (p.20)

"More Napier women would like to access the Napier low risk facility, but have to transfer for medical reasons or because beds are unavailable. Some women reported that they did not book into Napier because they couldn’t be guaranteed a bed in the unit and disliked the uncertainty." (p.27)

The Report’s recommendations (pp 43-45) were that the DHB should remain committed to providing low risk birth facilities for women who fulfill explicit clinical criteria, that "the low risk birth facility should be expanded to ensure that women who currently request births and postnatal stays are able to access the facility", and that "the low risk facility should be publicised and promoted in both Napier and Hastings [as] an alternative birth location".

The local survey highlighted (p.43) that

women were more satisfied with their care at the low risk facility in Naper than with the service provided at Ata Rangi, especially with reference to postnatal provision

Maori women were more likely to access a low risk facility and reported high satisfaction with the holistic approach to the care and support provided

Some women who responded to the survey wanted to access the low risk facility but were unable to – some for non clinical reasons but others because the unit was full or their midwife was working at Ata Rangi

Some women stated that they were unaware the low risk facility existed in Napier, or that they were eligible to access it.

"International research suggest that low risk units are clinically safe…, can be cost effective… and provide women with positive choices about their maternity care… However, it is essential that community buy in and support is developed and actively maintained", the report concluded. (p.44)

"It is exactly that community buy in and support which the DHB has failed to nurture", Dr Gwynn said. "The Report shows that the Napier unit is perfectly safe for those for whom it is intended. But expansion, publicity and promotion, the things that the Report highlighted as necessary, are exactly the things the DHB has failed to provide".

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