AMA position statement on Maternal decision-making

Maternal Decision-Making - 2013

Source: Australian Medical Association (AMA) 28/03/2013

1. A pregnant woman has the same rights to privacy, to bodily integrity, and to make her own informed, autonomous health care decisions as any competent individual, consistent with the legal framework of that jurisdiction.
   
2. A pregnant woman’s capacity to make an informed decision should not be confused with whether or not the doctor (medical practitioner) considers her decision to be reasonable, sensible or advisable. A doctor may not treat a competent pregnant woman who has refused consent to treatment. Recourse to the law to impose medical advice or treatment on a competent pregnant woman is inappropriate.
3. Most pregnant women strive to achieve the best possible health outcomes for both themselves and their unborn babies. ...

[Please click here to read the 10 points of the position statement.]

Position Statements often seem dry and meticulous, but they actually carry considerable weight.  It may seem strange that the AMA feels the need to declare that a competent woman has the right to make her own decisions - isn't that generally understood?

An article by Health Reporter, Melissa Davey, in today's Sydney Morning Herald newspaper noted the new Position Statement, and observed that "Previously, more emphasis was placed on on how maternal behaviours may damage a foetus, rather than the autonomy of a woman's decision."

[Read more: http://www.smh.com.au/national/health/trauma-pushes-mothers-to-home-birth-20130420-2i6wu.html#ixzz2R4VWeejx

In other words, in the past doctors were expected to take action that 'prevented' mothers from making foolish decisions, that may have led to adverse outcomes for their babies.  It's called 'shroud waving', and it usually works.


More discussion at villagemidwife.

MATERNITY SERVICES FOR TEMPORARY WORKERS IN AUSTRALIA

Public hospitals in Melbourne, and in other parts of this country, have closed their doors to women who do not have Medicare.  Women who present needing care at a public hospital are being told they must pay an $11,000 deposit, or leave without being attended to.  They are told to go to a private obstetrician, and make a booking at a private hospital, with an estimated $15,000+ cost to the woman.

The more affordable alternative is private midwifery services for planned homebirth, costing around $5,000.  However, an estimated 20% of women who are planning homebirth need to be transferred to hospital when their care needs exceed the capacity of midwives in the home.  These women arrive, with their midwife, at a public hospital, because they have no other option.  The midwife's duty of care to the woman and her baby is to refer to an appropriate service; regardless of the cost. 

Women who are in Australia on temporary work visas, such as 457, must have private health insurance.  However, it seems that the available insurance policies are woefully inadequate when maternity services are needed.  Women who have spoken to independent midwives, seeking to arrange their intrapartum and immediate postnatal care, have said that they simply can't afford the hospital fees.

This situation is unacceptable!

The time of childbirth, more than any other time of life, requires skill from the care providers, leading to security for the mother.  Although 'birth is not an illness' (WHO Fortelesa Declaration 1985), illness can quickly arise in pregnancy and birth, threatening the lives of the mother and her child.   

The data that midwives send to the Victorian Government Perinatal Data Collection Unit, and similar units in other States and Territories, and sent on to the Australian Institute for Health and Welfare, Mothers and Babies reports, does not give a field to identify the woman who are ineligible to use the national free public hospital services.  The outcomes will never be reported - they are likely to remain under the radar.


Is there a solution?

I would suggest at the very least that public hospitals need a process by which overseas workers, many of whom are from the poorest countries of the world, are able to access affordable maternity and neonatal care.  Yes, midwives can provide basic primary care in the community, at an affordable rate.  But, when a woman needs specialist obstetric referral, surely a 'no frills' option can be provided by the public hospitals, at considerably less cost than what is on offer from Melbourne's plush private hospitals.

Your comments are appreciated.