Is healthcare for babies and mothers really free?

Under the New Zealand public health system, maternity-related services provided by District Health Boards should be publicly funded for everyone who is a NZ resident or citizen, or whose partner is (Ministry of Health, 2018). But how much of the post-partum care women/people receive is actually free?

Our second child was born this January, and a week in, we’ve already spent a lot on healthcare for her and me. The public system gave us a great birth experience with a planned c-section, a room to ourselves in hospital, and two days and nights of care. In the lead-up to the birth, we had free obstetrics care because of my medical condition, we were entitled to a lead maternity carer/midwife and various monitoring services at the hospital when the baby had a low estimated birth weight and potential issues with the placenta (although it all turned out fine). None of these services are cheap.

But what of the care for mothers and babies post discharge from hospital? It’s a time when support can often fall away, and problems can set in. Midwives aligned with the local District Health Board visit every couple of days post-birth, and ours has been invaluable in giving her expertise on c-section healing, breastfeeding and how to get baby comfortable in their bed or basket. However, there are lots of other services that women/people need that may not be free or readily available.

 The first few days: what the public health system couldn’t provide

After a couple of days of breastfeeding, I was in a lot of pain and wondering what was going wrong. It didn’t feel like the last time I’d done it, although I’d also experienced different sorts of issues then. Our midwife checked the baby’s mouth. “She’s got a slight tongue tie. There could be a week or two wait, to get a referral to the DHB and get it seen to.” My heart plummeted. I couldn’t wait that long. Newborns feed about ten times a day and if I had to wait two weeks, that would be 140 feeds or almost 80 hours of painful feeding… and we just needed to get a bit of skin snipped. I couldn’t deal with the psychological or physical impacts of the pain, on top of trying to heal my body from birth and spending time with my busy toddler and new baby.

One of my friends had recently got her newborn baby’s tongue tie fixed, and had told me all about the experience: going to see a private lactation consultant, then driving to Palmerston North to get the tongue tie seen to. She’d endured weeks of painful feeding. So, I knew private care was a possibility. I got on the phone and made an appointment with my GP, to double check I didn’t already have an infection and see if they could give me some sort of topical painkiller/antibiotic. Then I phoned the private lactation consultant, and we spent all day driving to and from appointments. Back at home, we managed to get another lactation consultant to perform the actual snip (people must be qualified to do this) – we were extremely lucky she had an appointment slot that day.

True cost of care

All up, in one day, we spent:

• GP: $65.00

• Lactation consultant 1: $80.00

• Lactation consultant 2: $120.00

• = $265!

That’s quite a lot for the first week after birth. We have the privilege of having savings for these sorts of expenses, but often mothers and families don’t have that kind of money sitting around – especially when you’re on maternity pay. Other costs women/people may need could include physiotherapy for birth injuries or post-partum pain – that could cost you over $100-$150 per appointment, if not covered by ACC.

For women/people and their families to have the world-class healthcare we should get here in NZ, all of the costs of post-partum healthcare should be considered, not just those incurred in a hospital setting. Especially GPs – which are our first port of call for problems. If Government wants high rates of breastfeeding, problems need to be looked at straight away. Even if women/people opt for mixed feeding or don’t want to breastfeed, they may want the option of doing it – and if we can’t get help in a timely manner or access it publicly, that option could be taken away. It can feel devastating to not be able to do something you always imagined being able to.

It would be interesting to examine the private costs of post-partum care in the year after giving birth. Hundreds, or thousands of dollars could easily be spent. We shouldn’t just look at the direct financial costs either. What are the costs to mothers, babies and families of not having access to free healthcare, fast? Stress, mental health issues, post-natal depression, ongoing physical health problems and the de-prioritisation of one of our most profound experiences: having a baby, caring for them, and caring for mothers, in those important first few months of a baby’s life.