MATERNITY REFORM

Maternity services report delivers a healthy set of recommendations

Charles Darwin University Professor Lesley Barclay and Griffith University's Dr Jenny Gamble write in Crikey 27.2.09:

The Federal Government’s new report on maternity services is feasible and could just be what is needed to start the process of reform very much needed in Australia’s fragmented maternity services.

While the report correctly identifies that our services are generally of high quality and safe, they could be safer, less costly and more humane.

Operative birth is unnecessarily expensive and is increasing health care costs and pressures on operating theatres, delaying other necessary surgery. Operative birth introduces additional risk to women and their infants. We should return to a justifiable rate of risk and expense attached to caesarean birth in this country.

New risks in our system are birth by the roadside, being seen in rural areas as a consequence of closing small maternity services and the service avoidance being practised by too many remote Aboriginal women. They are dissatisfied with care they receive and concerned about risks to other children that occur if they leave.

The other risk, though one that is too seldom identified, is the risk of psychological harm experienced by women in current systems. In studies investigating the experience of over 1000 women, 30% reported that the birth of their baby was traumatic and were experiencing several (three or more) symptoms of post-traumatic stress disorder at six weeks postpartum.

One suspects the strong response for the review from women themselves reflects some of this distress and a strong motivation to increase women-friendly models of care which are less traumatic. Australian research led by Dr Jenny Gamble is currently investigating how we can reduce this distress.

There are no insurmountable barriers to this report being the first step in action for improvement as its title suggests.

There is much goodwill between midwives, obstetricians and GPs to make it work. Leaving home birth out probably has helped move us forward.

There are significant benefits for jurisdictions to get funding to support their midwifery models that currently do not get sufficiently well reimbursed or supported to expand.

The College of Midwives has a well-accepted professional review and scrutiny process for midwives wishing to take advantage of this professional development process. Women are clamouring for more midwife-based models of care. Evidence shows these are very safe and of high quality. Even better if they reduce operative birth rates, can be local, provided economically, and help women build confidence rather than leave them distressed.

How is the Improving Maternity Services report going down?
Join the discussion at our health blog, Croakey.