Mandates open letter

To Rt Hon Jacinda Ardern, COVID-19 Response Minister Chris Hipkins, Ministry of Health, New Zealand College of Midwives and Midwifery Council of New Zealand.

Unuhia te rito o te harakeke
If you remove the central shoot of the flax bush

Kei hea te kōmako e kō?
Where will the bellbird find rest?

Whakatairangitia, rere ki uta, rere ki tai;
Will it fly inland, fly out to sea, or fly aimlessly?

Ui mai ki ahau,
If you were to ask me,

He aha te mea nui o te ao?
What is the most important thing in the world?

Māku e kī atu,
I will tell you,

He tangata, he tangata, he tangata.
It is people, it is people, it is people

It is the 16th of November. It has been a heavy two days. Yesterday we felt the heaviness knowing that for some of our midwives it would be their last day, not knowing what the future holds. For other midwifes, it would be as normal a day as you can have being overworked and underpaid, and not knowing what the future holds. Today, we felt the heaviness of knowing that some of the people we saw now have lives that are suddenly and abruptly different from yesterday. We have felt the heaviness of grief.

43 years ago, in 1978, the Auckland Home Birth Association was founded amidst ever increasing medicalisation of pregnancy and birth and growing hostility and criticism towards midwives and the people they served.

It was a small but diverse group, joining together in common interest against what seemed like overwhelming opposition to fight for and protect their fundamental human rights. They were often criticised as being a “small minority”, not representative of the majority.

40 years later, we are still a diverse group – we have differing experiences, perspectives, beliefs. We are different ethnicities, genders, religions, orientations. We don’t always agree on the choices made or not made. We are not lesser for our diversity but the stronger for our differences. We are richer for our culture. Because at our fundamental core is respecting our right to informed choice. This was our māhi 43 years ago and it is our māhi today as it will be tomorrow and for all the days to come.

In a state of unreality, every single day, we find ourselves fielding messages and comments from people desperate to find a midwife and unable to do so:

“Do you know of any midwives available in ████. I don’t want to birth at hospital and I’m scared if I can’t find a midwife I will be forced to”

“there is a huge shortage in ███. I’ve been looking since █ weeks I’m almost █ and haven’t even talked to a midwife. Seems there are no home birth options available now and its causing me a huge amount of stress…I’d more be than happy to accept a no vaxx midwife. What [the government] are doing to everyone in this situation is unbelievable”

Or people looking to change midwives because their current one is pressuring them to get vaccinated:

“I’ve just been told today that my midwife doesn’t want to stay with me because I’ve chosen not to have the vaccination until it’s approved and fully tested. It’s been a hard journey for me to fall pregnant and this isn’t something I wanted for me or my unborn child. I’m just at the beginning at █ weeks so a long way to go!”

“My daughter is getting anxious because the midwife ██████ is strongly encouraging my daughter to get vaccinated”

People losing the midwife they’ve had previously because their midwife can no longer practice from today on.

“I’m going to lose my midwife. Yesterday my midwife informed me she can no longer practice. This is heartbreaking and so unnecessary”

“we will lose our midwife 4 weeks before giving Birth 😔😢

People whose family members can no longer attend their births, even as a support person, because it is the stance of NZCOM and the Midwifery Council that, “Once a midwife, always a midwife”

“My mum is a midwife. She’s been to all my births as well as the rest of our family. After the 15th I won’t be able to have her at my next birth because of these stupid mandates [….] No, not even as a support person. Its such bull█”

And finally, people considering unassisted birth for any of the above reasons. While still uncommon, we have noticed a definite increase in people considering and choosing this option.

Over a year ago in May 2020 we wrote a letter[1] about how badly midwives were being hit through the first lockdown. We were in crisis then. We are now faced with an even bigger crisis with hundreds of our precious midwives being forced out of the jobs they have given their hearts and souls to. And before there are cries of, “But it’s their choice”. No. No it isn’t. It is the choice of the New Zealand Government. Threatening people to do what you want by removing their ability to earn a living is not a choice. It’s manipulation and abuse of power.

40 years on from the founding of our original organisation, it is extremely distressing to see the same vilification and oppression of a “small minority” who want nothing more than their fundamental rights respected.

Where has the “Team of 5 million” gone? Where has “kindness” gone? Where has “Our empathy and strong sense of justice” gone? We would remind Prime Minister Adern of her own words, “That all people are equal. That everyone is entitled to have their dignity and human rights respected. That we must strive to promote social progress and better standards of life in larger freedom. And we must consistently hold ourselves to account on each.” [2]

We also would remind NZCOM what role the Auckland Home Birth Association and people like Joan Donley had in the formation of NZCOM and the introduction of the Nurses Amendment Bill 1990. [3][4] Where would you be but for the tireless efforts of a ‘small minority’ standing up for our rights?

In 1987 an inquiry was held to investigate the ethics of an experiment performed on a “small minority” of women. A result of that inquiry was the formation of the office of the Health and Disability Commissioner and the Code of Health and Disability Services Consumer Rights (HDC Code of Rights)[5]. A big win for human rights coming from just “a small minority” of women.

All through history, including our own, we find small groups of women at the heart of stories, standing up for not only their own rights but those of everyone. They knew, as we know now, that ‘minorities’ matter; that human rights are human rights are human rights.

That everyone has the same rights. Everyone deserves respect. Everyone has the right to be free from discrimination, coercion, and harassment. We all deserve full information and the ability to make our own choices based on that full information. We all must be able to give, withhold and withdraw consent freely. [6]

Midwives equally have the right to their own bodily autonomy just as it is part of their māhi to protect bodily autonomy. As one midwife of 25 years said, “How can I truely protect informed choice when mine has been taken”.[7]

Even aside from the ethical questions and human rights violations, we are facing a crisis of epic proportions. Our maternity system was already in crisis. Low wages, hostile and unsustainable working conditions have left our country with a severe shortage of LMCs, nurses and hospital core midwives. Minister Chris Hipkins, you assured us that the government would be “watching those numbers very carefully”[8] and yet every day, we have more and more people struggling to secure midwifery care.

Here we are on the 16th of November, yet another person urgently looking for a midwife. I could give no assurances. So, tell me, now that the writing is on the wall, are you actually doing anything or just continuing to “watch” the downfall of our maternity system? Are you considering the “public health risk” of people who are not able to access any midwifery care? Of hospitals turning people away who have just given birth because they don’t have enough midwives?[9] Of DHBs which were already unable to fill midwifery positions before mandates, let alone now that midwives are being forced out of their jobs and student midwives from their studies? That the crisis will further worsen as student midwives are no longer able to complete their training? Or the increasing number of pregnant people choosing to birth unassisted because they feel that’s safer than entering an understaffed, overwhelmed hospital? Is the Minister familiar with B.R.A.I.N.? It’s something we advocate for when making informed health decisions.

Benefits: What are the benefits?

Risks: What are the risks?

Alternatives: What are the alternatives?

Intuition: What do intuit about this situation?

Nothing (or Next steps): What if I do nothing? Or what are the Next steps?

Or as health providers are directed around informed choice- the benefits, risks, alternatives, and uncertainties.

Has Minister Hipkins fully considered the benefits and risks of mandates? Has the Minister considered the alternatives such as saliva testing? Saliva testing that the Ministry of Health itself recommends given that, as the Ministry of Health also informs us, vaccinated people can still get and spread COVID-19?[10] If pregnant people are crying out for the ability for their midwives to do saliva testing or they themselves to sign a waiver for their unvaccinated midwife, why is the Minister not listening? Why, as the Minister put it, are you locking into a course of action when there may be additional risks you have not yet identified?[11] You know, the uncertainties?

Auckland Home Birth Association asserts that mandates are not only ineffective but ethically and objectively wrong. We do not get to pick and choose who has rights and who doesn’t. Human rights are not controversial but fundamental, universal. Sovereign.

In the spirit of the home birth wāhine toa before us, we propose the following solutions:

  • That mandates immediately cease and midwives (including students) be restored to their urgently needed and rightful practices;
  • That alternatives to vaccination be made available to midwives and student midwives such as saliva testing, as per current Ministry of Health information;
  • That the midwifery scope of practice be revised so that midwives refer vaccination conversations to more relevant health providers such as GPs and concentrate on what they do best – pregnancy, birth, and postnatal care.

Our maternity system is built on the backs of dedicated women, talented and hardworking midwives and, as always, informed choice. Some of our midwives, to protect their bodily autonomy have had to leave their jobs and studies. Some of our midwives, against their bodily autonomy have been forced to get vaccinated to make ends meet. Some of our midwives, against their bodily autonomy, took the vaccine to make sure our pregnant people could still access care. Some of our midwives happily chose vaccination. All are now faced with a life that is different from yesterday. Each and every one deserves our support. Each and every one deserving of the same fundamental and inalienable rights.

He tangata, he tangata, he tangata.

We will leave you with these beautiful words from one of our amazing midwives

“I too wish to acknowledge and respect those who no longer practice – beloved sisters, I am sad to see you go, feeling your loss. To those who have made equally difficult decisions that too took choice from them – who paid another price to continue for survival, I equally acknowledge you for your heart and hard work. To those who face deepened times of difficulty with less support and greater requirement, I acknowledge your dedication to continue in tough times.To others who have paid the price of trauma in this work, leaving or in process of leaving-having left in your wake broken parts of your hearts – I acknowledge you and offer you warmth and love in your rebuilding. Dancing in the veil… the thinning translucency at times barely separating life from death at times crossing over… Hearts jolted, broken, and torn open. Sisters, Midwives of Aotearoa, I acknowledge you all equally, ♥️ with enormous love ♥️

Suzan Lee Anderson

N.B. Any responses to this letter from the addressees, will be posted here.

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