Opposition to maternity reform

The Australian has published Doctors firm against role of midwives, written by Adam Cresswell, Health editor | January 10, 2009.

"OBSTETRICIANS have stepped up their counter-attack against a push to give midwives a bigger role, claiming dire consequences will result if a federal review recommends allowing midwives to practise with inadequate medical supervision.

"With the federal health minister, Nicola Roxon, already on record as indicating some sympathy for the midwives’ pitch, specialist doctors say the Government should first consider what they claim are the ‘‘harmful effects’’ experienced in New Zealand, which moved to a midwife-led system in 1990.

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The need for reform of maternity services throughout Australia has been well established. Midwives are not interested in competing with GPs or obstetricians for medical or obstetric-surgical work. We simply want to be able to practise midwifery. And we expect to practise midwifery without medical supervision. Doctors do not know midwifery; midwives do. We collaborate with doctors when appropriate, in providing the best package of care that is suitable for each mother-baby pair.

The spokesman for obstetricians is Rural NSW obstetrician Pieter Mourik. He has been the spokesman for NASOG for many years.

Dr Mourik, who has retired from his obstetric practice, has established a national locum practice for obstetricians. The need for obstetric services in rural towns is undeniable, and Dr Mourik's initiative must be greatly valued.

Yet the other obvious fact is that midwives are also a scarce and valued community resource. Midwives who can practise the whole scope of midwifery.

Calls by midwifery organisations, and individuals, for reform of maternity care in Australia have in no way devalued the obstetrician or GP. Doctors cannot provide effective maternity services without the support provided by midwives, nurses, pathologists, physiotherapists, and all the complex teams in hospitals. The group of women for whom these services are appropriate are those with complications - a minority part of the spectrum within maternity consumers. The larger group of pregnant and birthing women and their babies are well: they do not need medical intervention.

A midwife who is providing primary care for a woman is expected to be constantly vigilant, and to collaborate with doctors and hospitals when complications arise or are suspected.

Midwifery in Australia today is a profession that is at a watershed. Either we will continue within the stiflingly restrictive environment of virtual medical supervision, or we will move into a new and exciting era of professional freedom. The former option will, I believe, lead to continuing escalation of the rates of surgical management of birth. The latter offers the only hope for midwives to become confident in our professional identity; promoting physiologically normal birth; and collaborating with other maternity service providers to achieve the best outcomes for all mothers and babies in our care.

Joy Johnston