– When I got the due date from the midwife, the first thing that struck me was: “Oh, it’s in the middle of Christmas. Even if the maternity ward is closed.” That’s what Åshild Pettersen says, who lives in Bardal in Leirfjord municipality in Helgeland. It provokes her that this was her first thought when she got the date. – That says a bit about the state of the offer for women’s health in Norway today. Because what is actually going on? Summer closure for 16 weeks In Helgeland this is what is happening: In order to save just over NOK 3 million, the company’s management is proposing to extend the summer closure of the two maternity wards in Helgeland. – They propose to extend from 8 to 16 weeks as a cost-saving measure. We don’t have such a long summer in Helgeland. I know I’m getting mad, says Åshild Pettersen. Last night, people demonstrated in Sandnessjøen against cuts in maternity services. Photo: Privat But the management at Helgelandssykehuset does not share the concern. – It is safe to give birth in Helgeland, even though maternity wards are closed for the summer, said acting managing director Hanne Frøyshov in a board meeting at Helgeland Hospital recently. Åshild Pettersen, head of Nordland SV, believes birth and due date should be a pleasant message, not a source of concern. Photo: Barbro Andersen / news And it is not just Helgeland that needs to be saved. Voss hospital must save 27 million, and the maternity ward may be closed this summer. Oslo University Hospital has recently decided to close the popular and midwife-run maternity ward ABC-klinikken at weekends. This is how they will save more than 3 million extra by extending the period An alternating closure of 8 + 8 weeks, compared to 4 + 4 weeks, will give an estimated financial gain of approx. NOK 3.2 million Here, it has been taken into account in the calculation that in the additional period of closure, further holiday and outstanding time off will be carried out, professional updating and some hospitalization will be carried out. This is absence of employees that you would otherwise have had throughout the year, and which experience has used hiring, extra shifts/overtime to cover. Further savings have been calculated on the hiring of gynecologists and midwives from companies, which is an expensive resource that maternity wards have used until now. Source: Annex to the board’s case on an extended period for summer-closed maternity wards in Helgeland’s hospital. The Midwives’ Association: – Blood-red figures in all health regions The Midwives’ Association is also critical of the planned new cuts in maternity services in several parts of the country when money is again to be saved. – We are listed. Now we see blood-red numbers in all health regions and then there are cuts in vital women’s health services all over the country, says Hanne Charlotte Schjelderup, leader of the Midwives’ Association. Hanne Charlotte Schelderup, leader of the Midwives Association, believes that we have enough money in Norway to ensure that the country’s women giving birth have a safe and sound maternity service. Photo: private – We see that as long as the hospitals are run as shops and must have earnings, a number of services are cut. She says there has been a deterioration since the National Audit Office came out in 2019 and said that the safety of women giving birth is threatened in Norway. Schjelderup adds: The Norwegian Directorate of Health has determined that the current funding model is not suitable for maternity care. The National Audit Office shows that the system leads to cost-saving measures that reduce the quality of the childcare provision. – We are experiencing a serious flight of midwives from the hospitals. It is urgent to change the current funding. Precarious shortage of midwives is a consequence of the health system not being rigged on the population’s premises. The Midwives’ Association believes that this is a serious system failure when this happens despite the fact that the enterprises were instructed to strengthen the maternity services in the government’s management requirements for operations. – The management at Helgeland’s hospital says it has gone well during the summer closure, is it so dangerous if you extend the period a little? – Previous results from a research project now led by the Institute of Public Health show that if the travel time is more than one hour, the risk of unplanned births outside the institution increases, says Schjeldrup. Such births have a higher risk of the child dying during birth or in the first day of life, compared to children born in a delivery room or hospital, explains one of the researchers for the project, Hilde Engjom. – There was also an increased risk of potentially life-threatening pregnancy complications in the mother, says Engjom. – Births are not profitable enough Pregnant Åshild Pettersen in Helgeland is also the leader of SV in Nordland. She is provoked by the fact that, in her opinion, developments in birth and maternity care are going in the wrong direction. – The food offer is almost the first thing to go down when there are savings measures. We see this not only in Helse Nord, but also in other healthcare organizations across the country. The managing director of Helse Bergen, Eivind Hansen, has told news that he is concerned about the consequences of hard cuts. This has, among other things, to do with the financing model, according to Pettersen. – Births are not profitable enough, she states and adds: – But basic health services for the population should not really be profitable. It must work, it must be safe and good for the population. Hospitals receive NOK 13,702 more for a normal birth, and NOK 32,584 more for a normal caesarean section. Here you can read more about what the hospitals get in return for a birth: This is how much the hospitals get paid for a birth Somatic services, i.e. medicine that treats physical challenges, will be financed with approximately 50% basic funding and 50% effort-based funding (ISF) in 2022. The hospitals code each treatment that is carried out, and are reimbursed the amount per treatment. This is done through the DRG system. DRG, diagnosis-related groups, is a system that classifies patients into groups that are medically and resource-wise similar. The system has been used to correct for differences in patient composition when comparing cost levels between somatic hospitals in Norway. (source Store medical encyclopedia) The figures below are from the Dips grouper. And is divided into births and caesarean sections with and without complicating secondary diagnoses (bk). 50% DRG – refund in kroner amount.Normal birth w/bk: 13702,-Normal birth w/bk: 20982,-Caesarean section w/bk: 32584,-Caesarean section w/bk: 45283,- The Directorate of Health tells news that they are not on a list of what comes first when the health authorities have to save in budget items. But Terje Hagen, head of department for the Department of Health and Society at UiO, says that what usually happens is that the hospitals reduce the planned activities. Terje Hagen, head of department for the Department of Health and Society at UiO, does not believe that there is any gender dimension in what health organizations choose to cut when the economy is tight. Photo: Peder Bergholt / news – These will often be planned operations in orthopedics or other areas. Then checks are postponed, he says and adds: – I don’t think there is any gender dimension here. Nevertheless, he believes that summer-closed maternity wards are a problem. Want central politicians on the field The leader of the Midwives’ Association is calling for political will from the government to halt the closure of birthing services and cuts in services at “the few birthing places we have left”. – In Nordland, we have long distances, harsh weather conditions and there is not a flight regularity that you can rely on and when it is urgent, says Schjeldrup. – We cannot gamble with the mother’s life and health with the announced cuts. But the Ministry of Health and Welfare believes it is safe to give birth in Norway. State Secretary Karl Kristian Bekeng in the Ministry of Health and Care points out that Helgeland’s hospital and other places find it difficult to recruit sufficient personnel both for municipalities and maternity wards in hospitals. Photo: Esten Borgos / BORGOS FOTO AS – It is the regional health organizations that are responsible for proper operation and staffing. I have faith that they will ensure a safe and good food supply throughout the country. This is according to State Secretary Karl Kristian Bekeng (Ap) in the Ministry of Health and Care. At the same time, he admits that, among other things, Helse Nord is in a demanding financial situation. He has therefore asked them to consider the need for changes in the division of functions and tasks. – Would you consider changing the current effort-based financing (ISF)? – The government has proposed to reduce the proportion of effort-based funding within somatics from 50 to 40 per cent in 2023, says Bekeng and adds: – This will give the regional healthcare organizations increased room for action, and may make it easier for the hospitals to prioritize tasks that do not generate income through ISF. – Does the ministry realize that the maternity services create insecurity and fear? – Fortunately, most are satisfied with the delivery and maternity care. At the same time, we must constantly work to ensure that women in labor have as good and safe an experience of the birth and maternity services as possible. ALSO READ:
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Closing maternity wards – Åshild Pettersen and the Midwives Association – news Nordland
