We’ve been forgotten: midwife

The country has millions of protective gowns, gloves and eyewear – midwives ask: Where are they? David Williams reports

Two days into a national lockdown some midwives didn’t have any protective equipment, adding to concerns about safeguards for frontline health workers.

On Friday, announcements were made by the Health Ministry and Minister David Clark about the country’s reserves of personal protective equipment (PPE), and new guidelines for their use. Clark said a Whanganui mask-making factory would increase production.

Those reassuring messages came amidst concerns from home care workers and other health professionals about the lack of equipment and potential problems with supply.

College of Midwives chief executive Alison Eddy says as of Friday afternoon, some district health boards hadn’t distributed any PPE gear to midwives. “I believe there are plans in place to do that. We’re hearing from these midwives that they haven’t yet had access to it.”

Eddy says the unsatisfactory lack of protective equipment for midwives has been raised for a couple of weeks, including at a daily meetings with the Ministry of Health. The message from the government has been that there is sufficient equipment. But Eddy says that after talking to midwives, it doesn’t seem the distribution and supply chain is established consistently throughout the country.

“The DHBs are putting in place plans to distribute it, but they’re having to almost ration it.”

One midwife, who didn’t want to be identified, says: “It feels very much like we’ve been forgotten. However, having read some of the articles that have come out from nurses, it sounds like we’re not the only ones.”

The woman tells Newsroom she’s been issued equipment but it seems inadequate – no hand sanitiser, no hospital-grade wipes, and only one face mask.

She’s baffled that it took until Friday for officials to reveal the country’s stocks of PPE gear. “Where is it? And why is it on standby two days into being on lockdown? To me that’s crazy.

“I would really like this to end in four weeks, as would everybody else, and these are the measures that will help it end.”

“We don’t think they should be putting themselves at risk if they feel that equipment’s needed and they don’t have it.” – Alison Eddy

Protecting healthcare workers in a pandemic is vitally important. They’re at high risk of catching communicable diseases. In the SARS outbreak, a fifth of all cases worked in healthcare.

It’s also a double whammy if they catch it – it reduces the number of healthcare professionals, putting strain on the health system, while, at the same time, adding to the tally of sick people.

In Italy, at least 41 healthcare workers have died from Covid-19.

The United States’ Centres for Disease Control and Prevention has been forced to issue new guidelines for PPE use because of shortages.

Back in this country, Eddy, the College of Midwives boss, says pregnant women are asked screening questions before visits. There’s also guidance about how midwives can minimise risks by, for example, keeping face-to-face meetings short, and maintaining physical distancing.

With the whole country in lockdown, Eddy says the vast majority of women won’t have any “risk factors” and protective equipment won’t need to be used. But its members are being urged to use their clinical judgement and don protective gear if necessary.

Midwives are anxious about the outbreak, she says, and the College is suggesting they cancel visits if they believe they’re unsafe.

“If the woman needs to seek care then she should be referred to a service, like a DHB service, where the equipment’s available. We’ve been absolutely clear our members, we don’t think they should be putting themselves at risk if they feel that equipment’s needed and they don’t have it.”

Most pregnant women won't have Covid-19 risk factors, says College of Midwives chief executive Alison Eddy. Photo: Supplied

Our anonymous midwife says Facebook groups are in uproar at the lack of protective equipment. The advice she’s been given is protective gear is only needed if someone has symptoms or is a confirmed case.

“I just think that’s BS,” she says. “We’re at 368 cases [on Friday] – we don’t know who has it and who doesn’t.”

She adds that overseas research shows many people have tested positive without having symptoms. “So how would one know whether people have it if they haven’t been tested?”

Limiting the time with women, including being in a room with them alone, and maintaining distance is not easy, she says – but her clients are understanding. “I feel terrible to not be offering them the best care that we usually give them, because we just can’t.”

These measures aren’t just for their protection – it’s for the protection of all their clients, and their families. The midwife wants the lockdown to end as soon as possible, but how can that happen if they can’t adequately protect themselves? “By not having appropriate PPE gear we are potentially able to spread the bug.”

Better late than never

The issue now appears to be taken seriously, after what looks like intervention from the Health Minister and the Ministry taking control of managing PPE supplies and guidance.

(Clark’s statement on Friday name-checked midwives: “Face masks and other PPE are vital tools for our doctors, nurses and midwives, and other essential workers at this time. These workers deserve all the support and thanks we can give them.”)

“That was good to see,” Eddy says, adding that the moves could have come sooner considering the issue has been raised “a lot”.

“But I think you also have to recognise the speed at which this is happening. It’s a rapidly changing environment and everyone is simply doing their best under the circumstances.”

On Friday, Director-General of Health Ashley Bloomfield said there were 1.9 million PPE aprons and gowns in the Ministry of Health and DHB reserves, as well as 2.7 million pairs of gloves and 60,000 sets of protective eyewear. In addition, there were 9 million surgical masks and 9 million higher-specification N95 respirators in the ministry’s reserves.

“All stones are being turned over to make sure we keep our stocks at the levels that will be needed to protect our health care workforce and essential workers,” Bloomfield said.

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