Tuesday, December 9, 2008

Maternity Services Review - Update

Approximately one half of the 900 submissions received by the Review are now available for public perusal at the Review website. There is plenty of interesting reading, both in the accounts of personal experiences in maternity care, in responses by special interest groups and organisations, and in large submissions by maternity-related professional bodies.

Here are a few snippets, to whet the appetite of blog watchers:
The Australian Society of Anaesthetists (ASA):
• believes that the existing model of obstetric care, where doctors and midwives collaborate together in a doctor led team, delivers the best maternity outcomes,
• ... and
• warns that proposals for change to the existing model of maternal care are driven mainly by social forces rather than concerns about the safety of mothers and their babies."

Women's Hospitals Australasia (WHA) ...
"recommends a national review of the medical indemnity insurance. ... WHA favours a universal no fault approach to medical insurance."

Midwives Naturally ..."We propose a changing of the entire system where funding is linked to the women (as in New Zealand). The client should be able to make an informed decision about where they give birth and with whom. Midwives are the only care providers who can provide a total service throughout the normal childbirth continuum. In order to achieve this, midwives must be able to order tests and ultrasounds, prescribe medications, within their scope of practice. At present midwives have to send their clients to other health care providers and this results in over servicing and increased cost to the woman. Midwives need visiting access to all hospitals. Currently some hospitals in Melbourne are refusing to allow women to make a backup booking for homebirth services, thus denying such women equal access to public health services that their hospital birth counterparts have full access to. This discriminates against women who are choosing home birth and therefore midwife led care, both of which are supported by research as being models of care that provide women with great satisfaction with their birth experience, less interventions and improved breastfeeding outcomes."

Australian Society of Independent Midwives
"Suggested changes to afford women a homebirth choice would include;

• Private Health Funds legislation making it compulsory for Funds to include
‘out of hospital birth’ packages alongside hospital birth benefits.

• Federal legislation to protect the public and the practitioners involved in
homebirths e.g. a National Midwife Practitioner Act

• Medicare provider numbers for Midwife Practitioners so that women do
not have to pay for the privilege of having their babies at home.

• Authority for Midwife Practitioners to request routine pregnancy
diagnostic and pathology tests

• Authority to prescribe emergency medications associated with the act of
giving birth e.g. life-saving oxytocics

• Professional indemnity insurance cover for Midwife Practitioners available
through Government-funded insurance schemes"

National Society of Specialist Obstetricians and Gynaecologists (NASOG):
"NASOG does not support the concept of independent midwifery led care for women in labour. As acknowledged at the review’s Models of Care round table consultation forum, all effective maternity care is collaborative. NASOG believes that it is preferable that a single individual carer take overall responsibility for care of a woman in labour and the obstetrician is the most appropriate choice for such a role. If a woman chooses to have care from a midwife, then NASOG believes that midwife should have a formal relationship with a nominated obstetrician/GP obstetrician."

Australian College of Midwives (ACM):
"While mortality outcomes for women and babies are good and comparable with other developed countries, there are nonetheless significant areas for improvement. Challenges include:
 the comparatively poorer mortality outcomes for Aboriginal and Torres Strait Islander mothers and babies;
 rising rates of caesarean birth with associated increased morbidity for mothers and babies;
 problems with equity of access to services especially for rural and remote women;
 the fragmented and stressful nature of care for most women, and in particular the lack of continuous support during labour;
 lack of choice for women wanting continuity of care (the only choice currently being a specialised obstetrician) For most women, there are no local services offering continuity of care by either doctors or midwives;
 an over-reliance on providing primary maternity care to mostly well women in acute hospital settings, which are increasingly overcrowded and understaffed; costly, and pose iatrogenic risks in terms of intervention, infection, medication errors, and other complications;
 lack of professional support postnatally, following discharge from hospital, to help in the critical early days and weeks with the transition to parenting a newborn baby
 shortages of midwives and GP obstetricians and a lack of co-ordinated strategies for addressing these shortages, and
 the current lack of accountability and transparency of services to consumers."

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCCOG)
"6. Home Birth
29. Home birth is NOT supported as it is associated with an unacceptably high rate of adverse outcomes.
30. RANZCOG recognises home birth will occur and therefore recommends minimum standards.
31. Women choosing home birth should be cared for by both an experienced medical practitioner and a registered midwife, each of whom has agreed to participate.
32. Women considering home birth should seek information from their home birth provider about the provider’s experience in home birth, and their contingency plan in the event of an emergency, including options for hospital transfer."

... ENJOY!
Your comments and discussion about these and other issues raised in the Review are welcome on this blog.

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