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 (ASIM)
"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.
Tuesday, December 9, 2008
Friday, December 5, 2008
NSW - Acute services in public hospitals
The final report of the Garling Inquiry into acute services in NSW public hospitals was released on Nov 27th.
Quoting from the overview, p24
"Mothers
1.151 I received a large number of submissions about maternity services and the need to give midwives more freedom and responsibility for being involved with helping mothers have babies.
1.152 This is a complex question because some of the matters I was asked to make
recommendations about really belong in the Commonwealth sphere and don’t fall within
my Terms of Reference. As well, there quite complex issues about safety and quality
which require careful thought. Nevertheless, I felt able, on the basis of the evidence which I received to make recommendations about enhancing the midwifery workforce, and seeing whether midwifery case-load models of care where the same midwife looks after the mother from their first appointment until about 4 weeks after the birth of the baby can be introduced to more hospitals than at present. I make a specific recommendation, in the interest of the safety of the mother and child which is that NSW Health only offer birthing facilities for low risk mothers in hospitals which satisfy the following criteria:
(i) the hospital has an adequate number of health professionals qualified and trained to assist with the birth, such as midwives or VMOs with the necessary credentials; and
(ii) the hospital has, on-site, or else has the ability to transfer the mother within 30 minutes travel time to a hospital which has on-site, the workforce and facilities to perform an emergency caesarean section." [Report, p24]
Quoting from the overview, p24
"Mothers
1.151 I received a large number of submissions about maternity services and the need to give midwives more freedom and responsibility for being involved with helping mothers have babies.
1.152 This is a complex question because some of the matters I was asked to make
recommendations about really belong in the Commonwealth sphere and don’t fall within
my Terms of Reference. As well, there quite complex issues about safety and quality
which require careful thought. Nevertheless, I felt able, on the basis of the evidence which I received to make recommendations about enhancing the midwifery workforce, and seeing whether midwifery case-load models of care where the same midwife looks after the mother from their first appointment until about 4 weeks after the birth of the baby can be introduced to more hospitals than at present. I make a specific recommendation, in the interest of the safety of the mother and child which is that NSW Health only offer birthing facilities for low risk mothers in hospitals which satisfy the following criteria:
(i) the hospital has an adequate number of health professionals qualified and trained to assist with the birth, such as midwives or VMOs with the necessary credentials; and
(ii) the hospital has, on-site, or else has the ability to transfer the mother within 30 minutes travel time to a hospital which has on-site, the workforce and facilities to perform an emergency caesarean section." [Report, p24]
Wednesday, December 3, 2008
Perinatal Data
The Victorian perinatal data collection unit (PDCU) has revised its data form, to be used from 1 January 2009. Midwives who are currently listed by the PDCU as those who attend homebirths will receive the new forms this month.
Five independent midwives attended a training day today, presented by the PDCU, to explain the changes to the form, and to discuss the planned electronic transmission of data from hospital data collection systems to the PDCU. Midwives reporting on homebirths, and small maternity hospitals which do not have the data collection systems running, will continue to fill out the forms manually, and post them to the PDCU. The information sent in hard copy will be entered into the system as it is at present.
New information fields that appear in the revised form include the aboriginality status of the baby as well as the mother; smoking; times of onset of labour, onset of second stage, and rupture of membranes; indication for induction; fetal monitoring in labour; waterbirth; amount of blood loss; hepatitis B Vaccination; and breastfeeding status. The leading intrapartum care provider (midwife, obstetrician, or GP) will also be recorded.
More information is available at the PDCU website http://www.health.vic.gov.au/perinatal/ , including the Guide for the completion of the Perinatal Morbidity Statistics form.
Five independent midwives attended a training day today, presented by the PDCU, to explain the changes to the form, and to discuss the planned electronic transmission of data from hospital data collection systems to the PDCU. Midwives reporting on homebirths, and small maternity hospitals which do not have the data collection systems running, will continue to fill out the forms manually, and post them to the PDCU. The information sent in hard copy will be entered into the system as it is at present.
New information fields that appear in the revised form include the aboriginality status of the baby as well as the mother; smoking; times of onset of labour, onset of second stage, and rupture of membranes; indication for induction; fetal monitoring in labour; waterbirth; amount of blood loss; hepatitis B Vaccination; and breastfeeding status. The leading intrapartum care provider (midwife, obstetrician, or GP) will also be recorded.
More information is available at the PDCU website http://www.health.vic.gov.au/perinatal/ , including the Guide for the completion of the Perinatal Morbidity Statistics form.
Tuesday, November 18, 2008
AUSTRALIAN DOCUMENTARY LOOKING FOR MIDWIVES
The changing structure of our 21st century family and work arrangements is deeply impacting on life experiences - particularly profound life moments such as birth, love and death.
We are hoping to get in touch with midwives to ask them their opinions about this - we are particularly interested in speaking with midwives who do not have their own children yet, but plan to have children in the future.
At this stage, this would not be a commitment to be in the documentary - we would just like to talk to women midwives about their thoughts and experiences as part of our preliminary research.
The documentary is planned to go into production at the end of February/beginning of March 2009 and will be shooting around the Sydney area.
The documentary has just been funded by Screen Australia - Australia's national film funding organisation. It is being directed by co-directors Tom Murray and Madeleine Hetherton. We are both experienced documentary makers who have directed a number of documentaries for broadcasters such as the ABC, SBS and commercial channels.
We would love to talk to you! Please call or email us if you would like more information.
Madeleine Hetherton 0408 6222 203 madspace@bigpond.com
Tom Murray M:0402 439 912 tarpaulin@ozemail.com.au
We are hoping to get in touch with midwives to ask them their opinions about this - we are particularly interested in speaking with midwives who do not have their own children yet, but plan to have children in the future.
At this stage, this would not be a commitment to be in the documentary - we would just like to talk to women midwives about their thoughts and experiences as part of our preliminary research.
The documentary is planned to go into production at the end of February/beginning of March 2009 and will be shooting around the Sydney area.
The documentary has just been funded by Screen Australia - Australia's national film funding organisation. It is being directed by co-directors Tom Murray and Madeleine Hetherton. We are both experienced documentary makers who have directed a number of documentaries for broadcasters such as the ABC, SBS and commercial channels.
We would love to talk to you! Please call or email us if you would like more information.
Madeleine Hetherton 0408 6222 203 madspace@bigpond.com
Tom Murray M:0402 439 912 tarpaulin@ozemail.com.au
Sunday, November 16, 2008
Victoria lags behind in maternity reform
Maternity Coalition MEDIA RELEASE
Sunday November 16 2008
Catch up Daniel Andrews - Nicola Roxon is way ahead
In September Health Minister, Nicola Roxon announced a review of maternity services, making it the 38th since 1985.
“We believe the only issue to have more inquiries commissioned is petrol prices. Women and their babies have been political hot potatoes, and we hope this is about to change”, said Deborah Loupelis, Victorian Secretary of Maternity Coalition and mother of 2.
Victoria is no different. In 2004 an excellent policy document was released, Future Directions. This document supports the establishment of primary midwifery care for women across the state.
“Instead of enhancement, since the review the state government has ripped midwifery apart, closing birth centres and the successful Rosebud maternity unit on the Mornington Peninsula.
“Maternity Coalition has been working for maternity reform for a long time. We have heard countless stories of women desperate for a better system. It is encouraging that finally a Federal Health Minister is listening. Minister Roxon has outlined the need for reform, flagging the enhancement of 1-2-1 care and indemnity protection for midwives across Australia.”
“We need Victorian Minister, Daniel Andrews to catch up. With an increase in births across the state many maternity units are bursting at the seams, they are simply not safe. Local primary midwifery services will give women safe, supportive and sustainable care.”
“Since September, women from all over Australia have been sending Maternity Coalition copies of their submissions to the Review. Initial feedback from the Department of Health has been that the total number of submissions they’ve received is overwhelming.”
“Although we have not been surprised by the volume of responses, we are buoyed by the depth of emotion from Australian women who support our vision of broadened maternity choices”.
“Today women from across Victoria will share the stories they have submitted, demonstrating how much 1-2-1 midwifery care has meant to them. They are gathering at TREASURY GARDENS from 1pm in a display of UNITY, ACTION & REFORM”
We applaud Minister Roxon’s positive stance, we understand, however, with 37 inquiries before that now is time for action. Women across the nation are saying there have been enough investigations. 1-2-1 midwifery care is the gold standard and women deserve that option now.”
Contact:
Janie Nottingham 0420620808
Sunday November 16 2008
Catch up Daniel Andrews - Nicola Roxon is way ahead
In September Health Minister, Nicola Roxon announced a review of maternity services, making it the 38th since 1985.
“We believe the only issue to have more inquiries commissioned is petrol prices. Women and their babies have been political hot potatoes, and we hope this is about to change”, said Deborah Loupelis, Victorian Secretary of Maternity Coalition and mother of 2.
Victoria is no different. In 2004 an excellent policy document was released, Future Directions. This document supports the establishment of primary midwifery care for women across the state.
“Instead of enhancement, since the review the state government has ripped midwifery apart, closing birth centres and the successful Rosebud maternity unit on the Mornington Peninsula.
“Maternity Coalition has been working for maternity reform for a long time. We have heard countless stories of women desperate for a better system. It is encouraging that finally a Federal Health Minister is listening. Minister Roxon has outlined the need for reform, flagging the enhancement of 1-2-1 care and indemnity protection for midwives across Australia.”
“We need Victorian Minister, Daniel Andrews to catch up. With an increase in births across the state many maternity units are bursting at the seams, they are simply not safe. Local primary midwifery services will give women safe, supportive and sustainable care.”
“Since September, women from all over Australia have been sending Maternity Coalition copies of their submissions to the Review. Initial feedback from the Department of Health has been that the total number of submissions they’ve received is overwhelming.”
“Although we have not been surprised by the volume of responses, we are buoyed by the depth of emotion from Australian women who support our vision of broadened maternity choices”.
“Today women from across Victoria will share the stories they have submitted, demonstrating how much 1-2-1 midwifery care has meant to them. They are gathering at TREASURY GARDENS from 1pm in a display of UNITY, ACTION & REFORM”
We applaud Minister Roxon’s positive stance, we understand, however, with 37 inquiries before that now is time for action. Women across the nation are saying there have been enough investigations. 1-2-1 midwifery care is the gold standard and women deserve that option now.”
Contact:
Janie Nottingham 0420620808
Wednesday, November 5, 2008
PICNIC at Treasury Gardens, Sunday 16 November, from 1pm
We are all invited to join Maternity Coalition for this picnic.
The theme is ‘Great Expectations’: The Future of Maternity Care in Australia
Federal Minister for Health, Nicola Roxon has recently set up a review into Australian maternity services.
The benefits of the care of a known midwife throughout, pregnancy labour and birth are well documented: they include reductions in surgery, increased rates and duration of breastfeeding, reduction in post natal depression, and greater maternal satisfaction.
Midwifery care that integrates clinical assessment and monitoring within a social framework, has considerable capacity to improve health and related outcomes for Indigenous women and others who are known to be at increased risk of poor outcomes.
The cost of maternity care has risen significantly. Obstetricians have increased their fees by 269% since the Medicare Safety-net was introduced in 2004. While midwives are educated and registered to provide the entire episode of care for healthy women (approx 75%) a lack of funding and indemnity insurance still prevents this. It is estimated that around 1% of midwives work to their registered capacity.
Maternity Coalition is uniting the women and midwives of Australia to support Minister Roxon’s work and seeks support from politicians across the country. Maternity Coalition is hosting community events across the country. There is considerable media interest.
On Sunday 16 November families from across Victoria will meet in Treasury Gardens from 1pm.
Please come and hear from women across the state regarding the current broken maternity system and how 1-2-1 community midwifery will transform services in both regional and metropolitan areas.
Should you be unable to attend would you please consider sending a message of support, because in someway birth affects us all.
Victorian Co-ordinator, Janie Nottingham (03) 59748364 or 0420620808
janie.nottingham@gmail.com
The theme is ‘Great Expectations’: The Future of Maternity Care in Australia
Federal Minister for Health, Nicola Roxon has recently set up a review into Australian maternity services.
The benefits of the care of a known midwife throughout, pregnancy labour and birth are well documented: they include reductions in surgery, increased rates and duration of breastfeeding, reduction in post natal depression, and greater maternal satisfaction.
Midwifery care that integrates clinical assessment and monitoring within a social framework, has considerable capacity to improve health and related outcomes for Indigenous women and others who are known to be at increased risk of poor outcomes.
The cost of maternity care has risen significantly. Obstetricians have increased their fees by 269% since the Medicare Safety-net was introduced in 2004. While midwives are educated and registered to provide the entire episode of care for healthy women (approx 75%) a lack of funding and indemnity insurance still prevents this. It is estimated that around 1% of midwives work to their registered capacity.
Maternity Coalition is uniting the women and midwives of Australia to support Minister Roxon’s work and seeks support from politicians across the country. Maternity Coalition is hosting community events across the country. There is considerable media interest.
On Sunday 16 November families from across Victoria will meet in Treasury Gardens from 1pm.
Please come and hear from women across the state regarding the current broken maternity system and how 1-2-1 community midwifery will transform services in both regional and metropolitan areas.
Should you be unable to attend would you please consider sending a message of support, because in someway birth affects us all.
Victorian Co-ordinator, Janie Nottingham (03) 59748364 or 0420620808
janie.nottingham@gmail.com
Monday, November 3, 2008
DELAYING CORD CLAMPING
Early cord clamping, immediately after birth and prior to cessation of pulsation of the cord, is performed routinely in many hospitals as part of managed third stage. Women planning to give birth in Birth Centres or at home will often be aware of the advantages to the baby of delayed cord clamping, or not clamping or cutting the cord, and request physiological 'unmanaged' third stage. This is the usual practice for many independent homebirth midwives.
An article in yesteday's Sunday Age, 'Trial to test benefit of delayed cord cutting' brought the welcome news that research is being undertaken - "leaving the cord unclamped for 60 seconds, holding the baby below the placenta and allowing gravity to let blood from the placenta enter the baby." The trial focuses on babies born more than 10 weeks early - the vulnerable, premature babies, who would not be likely to survive without expert neonatal specialist care.
In a normal birth setting - that is, a baby at term, spontaneous onset and progress of labour without stimulation, and spontaneous cephalic birth of a healthy baby - the mother herself is able to take her baby into her arms when she is ready. This may be immediately after the birth, or may be minutes later. There should be no need to put times and restrictions on the position of the baby.
The ICM/FIGO joint statement on active management of third stage is the 'evidence based' protocol followed in many major maternity hospitals.
"Active management of the third stage of labour consists of interventions designed to facilitate the delivery of the placenta by increasing uterine contractions and to prevent PPH by averting uterine atony. The usual components include:
· Administration of uterotonic agents
· Controlled cord traction
· Uterine massage after delivery of the placenta, as appropriate."
This protocol requires "Clamp the cord close to the perineum (once pulsation stops in a healthy newborn) and hold in one hand."
Waiting for pulsation to cease can be a precious time for the mother, in touching and observing her newly born child. A pulsating cord usually means the baby is OK. Even in the highly complex birthing situations a baby born with a pulse is likely to be fine.
I have observed many instances of actively 'managed' third stage in which the clamping of the cord is immediate, allowing a baby to be whisked away from the mother so that medical personnel can perform their ritual 'lifesaving' acts. This must have a profound impact on both mother and baby, interfering with bonding and increasing fear in both. Many mothers accept the interventions uncritically, believing that they were performed in the best interests of the child.
Professionals and parents need to critically examine the evidence around these serious interventions. Many lay people who read a blog such as this one may feel overwhelmed by the huge differences between holistic midwifery practice, and the highly interventionist obsteric services that are provided for the majority of women. As an immediate action that anyone who is concerned that their baby's umbilical cord may be clamped prior to cessation of pulsation, should discuss with their care providers and ask what is their usual practice.
Any midwife or doctor who is willing to clamp a pulsing cord should, in my opinion, be challenged.
Joy Johnston
An article in yesteday's Sunday Age, 'Trial to test benefit of delayed cord cutting' brought the welcome news that research is being undertaken - "leaving the cord unclamped for 60 seconds, holding the baby below the placenta and allowing gravity to let blood from the placenta enter the baby." The trial focuses on babies born more than 10 weeks early - the vulnerable, premature babies, who would not be likely to survive without expert neonatal specialist care.
In a normal birth setting - that is, a baby at term, spontaneous onset and progress of labour without stimulation, and spontaneous cephalic birth of a healthy baby - the mother herself is able to take her baby into her arms when she is ready. This may be immediately after the birth, or may be minutes later. There should be no need to put times and restrictions on the position of the baby.
The ICM/FIGO joint statement on active management of third stage is the 'evidence based' protocol followed in many major maternity hospitals.
"Active management of the third stage of labour consists of interventions designed to facilitate the delivery of the placenta by increasing uterine contractions and to prevent PPH by averting uterine atony. The usual components include:
· Administration of uterotonic agents
· Controlled cord traction
· Uterine massage after delivery of the placenta, as appropriate."
This protocol requires "Clamp the cord close to the perineum (once pulsation stops in a healthy newborn) and hold in one hand."
Waiting for pulsation to cease can be a precious time for the mother, in touching and observing her newly born child. A pulsating cord usually means the baby is OK. Even in the highly complex birthing situations a baby born with a pulse is likely to be fine.
I have observed many instances of actively 'managed' third stage in which the clamping of the cord is immediate, allowing a baby to be whisked away from the mother so that medical personnel can perform their ritual 'lifesaving' acts. This must have a profound impact on both mother and baby, interfering with bonding and increasing fear in both. Many mothers accept the interventions uncritically, believing that they were performed in the best interests of the child.
Professionals and parents need to critically examine the evidence around these serious interventions. Many lay people who read a blog such as this one may feel overwhelmed by the huge differences between holistic midwifery practice, and the highly interventionist obsteric services that are provided for the majority of women. As an immediate action that anyone who is concerned that their baby's umbilical cord may be clamped prior to cessation of pulsation, should discuss with their care providers and ask what is their usual practice.
Any midwife or doctor who is willing to clamp a pulsing cord should, in my opinion, be challenged.
Joy Johnston
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