Midwives are pleading with the NSW government to fix the "broken" staffing system in public hospitals, claiming that staff shortages, inadequate training and ongoing unfilled vacancies are placing mothers and babies at risk.
The NSW Nurses and Midwives’ Association has asked Health Minister Brad Hazzard to introduce mandated midwife-to-patient ratios in maternity wards - at least one midwife to three mothers in postnatal - but this has been knocked back.
NSW Health denied there was a shortage, saying this year it had employed 134 new midwives, and that 190 registered nurses had started training to become midwives.
A survey of more than 1000 midwifery members has found about 90 per cent have contemplated leaving the profession, with 80 per cent blaming "understaffing and staffing problems" and 40 per cent citing "dissatisfaction with rosters".
Two-thirds of the respondents work part-time or casual. However, a 90 per cent said they would increase their hours if mandated ratios or better minimum staffing requirements were introduced.
"The survey results were worse than I expected," Judith Kiejda, the union's acting general secretary, said.
"When you've got 90 per cent saying they would work more if they had the right environment, then you know the problem is the workload. The midwives are there and they'll work more if the conditions are right."
The survey follows a series of strikes and protests by midwives at hospitals across NSW in November, including at Prince of Wales, Royal Prince Alfred (RPA), Nepean and Blacktown hospitals.
It also comes after midwives at RPA, Royal North Shore, Wollongong, Liverpool, Blacktown, Nepean, John Hunter, Tweed, Lismore and Tamworth wrote an open letter to Mr Hazzard saying mandated ratios were required to fix the "broken" system.
In this letter they detailed how the high number of vacancies and overtime were forcing educators and midwifery managers to "constantly work on the floor" instead of providing "adequate training" to junior staff.
They wrote there wasn't enough time for them to provide the support and education that new mothers needed, leading to a steady decline in breastfeeding, from 82 per cent breastfeeding at the time of discharge in 2011 to 74 per cent last year.
"You need to have somebody qualified showing you how to breastfeed, and if you get it right at the start, you'll have much better outcomes," Ms Kiejda said.
She said the government had rejected the union's demands for mandated ratios, while it was still trying to convince the Labor opposition.
Cherie Desreaux, who has worked as a midwife for 14 years, said that her maternity ward was often down one person during the week and down about three people on the weekend.
"If we're lucky, we'll have seven or eight midwives on, but there should be nine because we can have nine women labouring at one time in our nine-bed facility," she said.
"The recommendation is that labouring women should have one-to-one midwifery care. We're seeing women delivering a 23-weeker [baby], women with pre-eclampsia, and they need one-on-one care for their safety and their baby's safety."
NSW Health said the 2018-19 budget provided $8.1 million to recruit a further 80 new specialised nursing, midwifery and support positions, fulfilling the government’s 2015 election commitment to employ an additional 360.
"Many factors influence a mother’s decision to breastfeed their baby including cultural and social factors," a spokesman said.
"The rate of babies receiving any breast milk at all has increased by 8.6 per cent and the rate of formula feeding has decreased by 2.4 per cent over the same period."
NSW Health said it uses evidence-based midwifery workforce planning to determine the staffing requirements, based on the needs of women for midwifery care throughout pregnancy, labour and the postnatal period.
