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Midwives are actively encouraging women to pursue a different career, as the toll of COVID-19 lays bare a culture of overwork in the profession that stems from long before the current health crisis.
An experienced midwife told Newshub her colleagues were already "leaving the profession in their droves", disgruntled by poor pay, the unmanageable scope of their work and a lack of Government support.
But now it's at a tipping point, with midwives saying they're still being overlooked by the Government despite the additional demands of the coronavirus outbreak - including staff shortages, heightened health risks and a lack of personal protective equipment (PPE).
Katarina Komene, an Auckland DHB midwife who's been in the profession for eight years, says things have sunk to a new low during the coronavirus crisis.
She says the additional stress load of "expectations put on us by the Ministry of Health" have left them "burnt out and physically, mentally and emotionally spent".
"New graduate midwives right through to experienced midwives are leaving our profession in their droves. Those who've been in it for a while are just over it - they're over being undervalued," Komene told Newshub.
"They're leaving to do other jobs or they're leaving to go to Australia, where they can get far better pay for far less responsibility. To be very honest, those who have been midwives for a while say to those women who'd like to be one 'don't do it - it's not worth it'."
And that advice - along with the swathe of negative press coverage that's emerged during the COVID-19 crisis and earlier - appears to be having an effect.
Alison Eddy, chief executive of the New Zealand College of Midwifes (NZCOM), says she's heard from many midwife colleges who have suffered reduced applications in recent times.
She says it's undeniably affecting midwives' morale, and has grave concerns that the negative publicity is deterring young people from applying for the programmes.
'Our scope of practice is huge': Why midwives are desperate for Government action
Much of the anguish from midwives about Government inaction centres on their wide scope of practice, which they say is overlooked by the Ministry of Health and undermined by the current legislation.
Under the Section 88 notice in the New Zealand Public Health and Disability Act (2000), lead maternity carers are only paid to look after their client and their baby - which means they're not properly compensated for the additional work they do.
Midwives are desperate for proper pay - but this is entirely contingent on the Government, which is responsible for funding them.
"[Midwives are] sort of in this place where they're pseudo-self-employed in lots of ways - they have no ability to recoup extra costs, or if they have to work more there's no flexibility in the system to reflect that," Eddy explained.
And they are working more. In March, just before the COVID-19 outbreak, an NZIER report noted that community midwives were working up to 26 percent more than was expected of a full-time equivalent.
Komene, whose clients are predominantly Māori and Pasifika women from low socio-economic backgrounds, says the Government has no idea if it thinks their jobs are just about looking after women and babies.
"If there's family violence issues we've got to do referrals; same thing if there's mental health issues, financial issues, housing issues - everything. We look after women and their whānau holistically," she told Newshub.
"We're only engaged by that hapū māmā to look after her and her baby - that's our scope of practice - but we don't just do that.
"You can't walk into a home and see that the children have no warm clothes, no beds to sleep in, no food on the table, no petrol to get to the doctor, no roof over their heads, no nothing - and then say 'sorry, I've just come to feel your baby, see ya later'.
"It just doesn't happen. Our scope of practice is huge."
Eddy says NZCOM has been in negotiations with the Government to get an improved funding model for "well over four years" but now - even amidst the coronavirus crisis, with things at their worst - it refuses to budge.
"We still don't have a proper funding model. We just haven't got the traction that we've wanted, and this coronavirus environment has exacerbated that," Eddy said.
"They are not listening to the challenges that we've got, the extra expense that it's costing us or the extra stress that it's costing us," Komene adds.
How COVID-19 has made things even worse for midwives
When the Prime Minister announced New Zealand's alert level system in late March, it threw up a few curve balls for frontline health staff across the board. For midwives, it's made their jobs more complicated, more time-consuming and more dangerous.
Many midwives who had pre-existing respiratory conditions or in their 60s and 70s stopped working overnight, which spread the remaining workforce - who were already exhausted from overwork - even more thinly.
"We don't have enough staff, and even prior to COVID-19 we didn't. The main reason for that is pay inequity and stress levels," Komene said.
Recently NZCOM requested that the Government reimburse midwives for some of their additional costs and work during this time - but Eddy says this, like the push for a better funding model, was rejected.
"They didn't do that, [even though] they're immediate things the Government could do that would send a real signal that they do value the workforce."
Eddy says the COVID-19 crisis has been somewhat of a tipping point for midwives, whose frustrations are rising to the fore more than usual due to the heightened staffing issues, overwork and health risks.
"Families might need transport assistance to get to appointments if they live rurally, for example - so midwives have noticed their workload increase," Eddy said.
"The point we've been making to the Government is that midwifery doesn't have a lot of structures around it... midwives have had to fill the gaps in a number of services, or navigate access to them."
Komene is now well-accustomed to the extra demands of midwifery in the era of COVID-19. But she says initially her household - which spans four generations, including her elderly parents - begged her not to go to work.
"They were watching the news seeing there's not enough PPE out there, there's health workers dying all over the world from this - midwives included - or bringing it home to their families, who are also dying," she explained.
Komene herself has gone to great lengths to protect her whānau during the COVID-19 crisis. Every day she gets home from work she removes her clothes, puts them in a hazardous waste bag and goes straight to the shower. It's only then that she feels safe enough to make contact with her family.
Quarantine and consultations in the rain: Why there's concern for mums-to-be
While Komene's time at work has presented a myriad of challenges to her own health, she and her colleagues are also worried about their clients - particularly those in some of Auckland's poorest communities.
She says Ministry of Health guidelines - which urge health workers to avoid face-to-face consultations and spend no more than 15 minutes in a client's home - are unrealistic.
"That's easy for them to say. My clients don't have access to Zoom or video call or internet or credit on their phones - so how do I get in touch with them?" Komene told Newshub.
"If I'm concerned about a baby in a hapū māmā's puku, I've still got to go to her home - otherwise we're going to end up with dead babies in our community."
While Komene has adhered to the rules as much as possible, she fears it could come at a cost despite it preventing the spread of the disease.
She has been visiting these women at their homes - but sometimes, due to the health risks of such visits, has been forced to hold antenatal consultations through her car window as the women stand outside in the rain.
Of particular concern to Komene, though, is the mental health of pregnant women quarantining in hotels. She has been working extensively with these women during the COVID-19 crisis, and says they're struggling with a lack of support from friends and family.
"Mums are coming from all over the world, they're anxious and scared," Komene said.
"We're talking about women through this time who are losing their babies and can't have their whānau supporting them - we're talking about Māori and Pacific women who are used to having their whole whānau there."
She said one hapū māmā - a first-time mother who gave birth in Auckland after flying in from her native Tonga - has been left completely alone in a hotel room except for midwife visits for two weeks.
For many women, but particularly Māori and Pasifika, it has been tough to go it alone.
'We keep doing what we're doing'
Despite the challenges - and even in the face of extra demands brought on by the coronavirus outbreak - Komene and Eddy are eager to communicate that midwifery is still a rewarding career.
"You come into this profession because you love people and want to make a difference in people's lives - we keep doing what we're doing," Komene says.
"It's a fantastic career," adds Eddy, "and we have an amazingly committed group of women who are great at what they do. We don't want to discourage people from becoming midwives.
"But at the same time, we desperately need conditions to improve so we can retain the workforce and attract people to become midwives."
