Hard News by Russell Brown

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Hard News: Complaint and culture

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  • Russell Brown, in reply to Sacha,

    Which takes us back to the North&South article. Where is the emphasis when the cover has the word ‘Midwives’ blazing on it and the whole beginning of the story is about only their alleged failings? It’s hardly neutral territory given the history

    But the big change was autonomy for midwives. There are now only about 30 obstetric GPs in the whole country; 3000 midwives and 225 obstetricians. ACC treatment claims for maternity care out of proportion to their share of all medical treatments. A Canterbury University (by an economist, mind you) that found having a GP not a midwife reduced infant mortality by 10%. A doubling of the proportion of live births that result in hospital admissions between 1999 and 2007.

    The is evidence the other way too. But if you’re going to talk about the impact of the changes, you do have to talk about what the changes look like.

    Auckland • Since Nov 2006 • 22850 posts Report Reply

  • Emma Hart,

    Danielle is producing my comments very slightly in advance. This time I hadn't even started typing "how do you know it's not breast milk in the bottle?"

    It's very easy to buy a baby doll without a bottle. Not so easy to buy one that comes accompanied by a disembodied breast.

    Christchurch • Since Nov 2006 • 4651 posts Report Reply

  • jessica scott,

    Notice how they only advertise “toddler milk”

    Which has been argued was invented purely to get around the advertising rules which ban formula being advertised for newborns. It still is advertising the brand.

    Wellington • Since Mar 2010 • 20 posts Report Reply

  • Deborah,

    I’m spluttering with rage here…. so I’m telling myself to breathe, just breathe, calmly, calmly…..

    I have friends with new twins who didn’t get to see a lactation consultant for FOUR DAYS. That can be the difference between success or failure with breastfeeding.

    That is EXACTLY what happened to me, even though I had on my fcking birth plan that I wanted to see a lactation consultant as soon as the babies were born. The only other thing on my birthplan was, “I will do whatever is needed to get these babies out alive.” And the fcking allegedly baby-friendly hospital couldn’t even come up with a lactation consultant until the day I was leaving. And by that stage, the critical point had passed for me, due to the complication of having had breast lumps removed in the past that compromised my chances of feeding twins successfully. I might just have been able to do it if the lactation consultant had bothered to come and see me when I asked, or maybe even the next day.

    I proffer that those with that attitude are more likely to not have problems with “the latch” and other issues.

    I very rarely think that you have to have actual experience to offer an opinion. For example, I really value Jackie’s contributions on parenting, because I know her to be a woman of great knowledge and warm heart and stout character. But really, until you have tried to breastfeed yourself, perhaps you might just hold off on opinions that the only thing going wrong is something in the poor wee dear’s lady brane.

    Damn straight, all other things being equal, formula is second best. But it’s second best, not bloody poison. In a first world country, where our parents are literate, and our access to potable water excellent, there is NOTHING WRONG WITH FORMULA.

    Actually, I’m getting all angry again now… so I’m going to hit ‘post’ on this before I say something I really regret.

    New Lynn • Since Nov 2006 • 1447 posts Report Reply

  • James Butler, in reply to jessica scott,

    Notice how they only advertise “toddler milk”

    Which has been argued was invented purely to get around the advertising rules which ban formula being advertised for newborns.

    Hmm, I suspect it was invented just as much because the industry produces more dairy whey byproducts than infant formula alone can use up.

    Auckland • Since Jan 2009 • 856 posts Report Reply

  • Danyl Mclauchlan,

    I'm not sure any rule-bending ad campaign can compete with the lactation consultant at our breastfeeding class insisting that it will be 'difficult for formula feeding mothers to get jobs, because employers prefer to hire women who breastfeed'.

    I still amuse myself by imaging our HR reps reaction if I asked someone in a job interview whether or not they were breastfeeding.

    Wellington • Since Nov 2006 • 927 posts Report Reply

  • jessica scott, in reply to Emma Hart,

    Wellington • Since Mar 2010 • 20 posts Report Reply

  • George Darroch,

    The is evidence the other way too. But if you’re going to talk about the impact of the changes, you do have to talk about what the changes look like.

    Should be the start of any debate, really. I don't have an opinion - really - but in this case (unlike many others) there's a readily identifiable and stable metric, in the form of mortality. Using that as a starting point (and any other consistent and justifiable measures) seems fairly sensible to me.

    Were we able to freely access academic journal articles, we might be able to examine such evidence.

    Likewise, the evidence on breastfeeding.

    WLG • Since Nov 2006 • 2264 posts Report Reply

  • Sacha, in reply to Russell Brown,

    And p46 of the article notes that the rate of HDC complaints is proportionally higher about obstetricians than midwives. The magazine's framing of the story concerns me more than the detail, frankly.

    Ak • Since May 2008 • 19745 posts Report Reply

  • B Jones,

    Until the Public Address webmonkeys work out how not to make the site crash on my Android mobile, I'm afraid breastfeeding will continue to be very difficult to combine with arguing about it online.

    Wellington • Since Nov 2006 • 976 posts Report Reply

  • Carol Stewart, in reply to George Darroch,

    Were we able to freely access academic journal articles, we might be able to examine such evidence.

    Nice threadmerge, George!

    Wellington • Since Jul 2008 • 830 posts Report Reply

  • B Jones, in reply to Danyl Mclauchlan,

    difficult for formula feeding mothers to get jobs, because employers prefer to hire women who breastfeed

    *Gulps with hysterical laughter* Anyone who can keep up breastfeeding while working in an office, let alone a shop or factory floor, has my congratulations and admiration.

    Wellington • Since Nov 2006 • 976 posts Report Reply

  • Russell Brown, in reply to Sacha,

    And p46 of the article notes that the rate of HDC complaints is proportionally higher about obstetricians than midwives.

    From a very small sample on the specific issue of code of rights complaints -- which aren't the same thing as medical outcomes.

    From the last batch of 44 complaints about obstetricians, one was upheld. From the 97 complaints against midwives, five were upheld. So you could also say that complaints against midwives are more than twice as likely to be upheld as complaints against doctors.

    The magazine’s framing of the story concerns me more than the detail, frankly

    I disagree.

    Auckland • Since Nov 2006 • 22850 posts Report Reply

  • Sacha, in reply to George Darroch,

    we might be able to examine such evidence

    As the article notes (and Russell emphasised), we lack the relevant local evidence base so it's good to see the Minister quoted as financing some of the data side of that.

    Ak • Since May 2008 • 19745 posts Report Reply

  • Sacha, in reply to Russell Brown,

    I disagree

    I encourage you to think of how the Linda Bryder kerfuffle went down, and the establishment blocs pushing this type of 'debate' in the background.

    Ak • Since May 2008 • 19745 posts Report Reply

  • Carol Stewart, in reply to B Jones,

    It's not exactly what you're talking about, but I had a colleague who would think nothing of expressing breast milk in the middle of a meeting. I'm happy to have worked in a team where everyone just took it in their stride.

    Wellington • Since Jul 2008 • 830 posts Report Reply

  • Sacha, in reply to Russell Brown,

    code of rights complaints -- which aren't the same thing as medical outcomes

    Yes, and the article acknowledged them as a proxy in the meantime. Having to resort to that does seem nuts.

    Ak • Since May 2008 • 19745 posts Report Reply

  • B Jones, in reply to Russell Brown,

    So you could also say that complaints against midwives are more than twice as likely to be upheld as complaints against doctors.

    Not without committing major selection bias. OBs are far more likely to be involved at the risky end of the business, when things go wrong.

    I don't think the story backs its conclusions either. The anecdotes illustrate what can go wrong, but the uterine rupture thing sounds like it's as much the registrar's fault for giving the mother too much syntocinon as the midwives' for letting her push too long. That's something that could happen under the old system - it's not like OBs showed up at every actual delivery.

    Wellington • Since Nov 2006 • 976 posts Report Reply

  • Sacha, in reply to Russell Brown,

    So you could also say that complaints against midwives are more than twice as likely to be upheld as complaints against doctors.

    You could, though as you note there are a total of:

    3000 midwives and 225 obstetricians

    Ak • Since May 2008 • 19745 posts Report Reply

  • Russell Brown,

    Anyway, gotta run and do the show.

    As I noted in the the original post, the result of our n=1 study was that a home birth with a midwife was good and emotionally satisfying (and that's very important) and I don't regret doing it for a second.

    Our hospital experience was not as satisfying -- but I do sometimes wonder what could have happened if that birth had taken place outside a hospital.

    Auckland • Since Nov 2006 • 22850 posts Report Reply

  • Sacha, in reply to B Jones,

    the uterine rupture thing

    Clearly described as the registrar's fault - but as you say not allowed to interfere with the desired conclusion.

    I simply don't have time to fisk the article but even given my limited knowledge of maternity policy, it's hardly a balanced account.

    Ak • Since May 2008 • 19745 posts Report Reply

  • Sacha, in reply to Russell Brown,

    Anyway, gotta run and do the show.

    Truth to power, sir.

    Ak • Since May 2008 • 19745 posts Report Reply

  • recordari, in reply to Deborah,

    Actually, I’m getting all angry again now… so I’m going to hit ‘post’ on this before I say something I really regret.

    Thank you Deborah for this post and for sharing your story. It further confirms my view that this is an individual thing, and comparing it to farming, coaching sports or anything other than what it is for the mother in question deserves all the ridicule and ranting it gets.

    AUCKLAND • Since Dec 2009 • 2607 posts Report Reply

  • Russell Brown, in reply to Sacha,

    I guess I’m also influenced by the knowledge that Chisholm has bloody good journalistic judgement, and a long record of dealing with with scientific issues in her stories.

    Apart from anything else, I get the impression that had she really been intending to write anti-feminist stitch-up, her hour-long interview with Guililand gave her plenty of material. But she didn’t go that way.

    Auckland • Since Nov 2006 • 22850 posts Report Reply

  • Sacha, in reply to Russell Brown,

    But she didn't go that way

    She was framed explicitly from the outset (p48) as an angry woman.

    For College of Midwives’ Guilliland, the debate over the quality of midwives is frustratingly, tediously circular and anti-feminist. To call Guilliland defensive is to understate the sense of pent-up fury which colours her responses to the “same old” questions about training and competence.

    Anyway, hope you have someone to interview with more of the relevant policy context than any journalist can afford to build up. It's an important topic.

    Ak • Since May 2008 • 19745 posts Report Reply

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