The Ideology Behind Our Maternity Policy

Over the last week or so there has been a lot of media attention directed at New Zealand's provision of Maternity care. There has been some criticism of midwives, and comments pointing out how few doctors are now available to do maternity care.

David Farrar wrote a post about the current midwife situation and he filed it under political correctness. The problem is the dominant ideology in the provision of maternity care isn't 'political correctness' (whatever the fuck that means), but neo-liberal economics.

In the mid-1990s the National Government introduced a new payment scheme for childbirth. Under this scheme each woman had to nominate a Lead Maternity Carer and there was a fixed sum available for each birth (there was more money for more complicated pregnancies). If the Lead Maternity Carer wanted to work with another professional, than this professionl's fees had to be paid out of the fixed sum available for the birth.

My sister was born at home in the late 1980s, before this system came in. My Mum had a midwife present all the time, and her doctor was there for a much shorter period of time (I don't know how they divied up the pre and post natal care). The doctor also ran a weekday practice, and my sister was born at 2.30 in the morning - so I'm not quite sure how GPs who did maternity care balanced all that out then.

This explains why most GPs no longer do maternity care. If a similar situation was going to happen now the doctor would have to pay for the midwife out of the fixed sum of money available for the birth. The new system meant that it was no longer worth it for GPs to do maternity care. They weren't driven out by anything but cost saving economics.

Government subsidies at a fixed price is part of the neo-liberal plan for our health system (and other areas of public services as well). On one level it is simply a cost-saving plan, as it fixes the costs the government will be liable per birth. But it also part of a larger trend towards commodification and privatisation of the health service. Firstly this plan created a gap, care by a doctor during maternity that could be filled by private health providers. Secondly a fixed price, rather than meeting the costs, the state began the process of turning maternity care into a commodity, as opposed to a service.

It is true that the change in the funding structure happend at the same time as the status of midwives changed, but that wasn't a necessary connection.