Midwifery debate

The following responses were sent to the Editor of newspapers which published a small article 'Doctors Attack Midwives Proposal'


The statements by the Australian Medical Association, reported in The Age (In Brief p10, 11/12/08) saying the Federal Government’s plans to extend the role of midwives “could threaten the lives of mothers and their babies” and “there was a greater chance of a baby dying during birth if born at home” are not based on any evidence.

Homebirths attended by midwives in Victoria are reported to the government’s Perinatal Data Collection Unit, and reports are published annually. The statistics for women who intended homebirth but transfer before or during labour are also available. Although these reports cannot give specific information on individual cases, the data do not suggest any cause for concern about the midwives’ competence in practising midwifery.

I am an independent midwife, so I obviously have an interest in asking for the right of reply. However, I do not want special treatment – I believe newspapers should look for and report on the truth. In this case the homebirth midwifery profession is small and poorly funded, threatened with extinction, and we are being attacked by a huge, well organised, and well resourced organisation.

Joy Johnston

It is to be expected that the AMA as a medical trade union would attack any discussion on midwives’ roles in the health system (Doctors Attack Midwives Proposal September 11th). We must, however, challenge the inaccuracies used in their response.

Firstly, the Maternity Services Review is not about homebirth but about facilitating women's choice in a safe, informed environment. The majority of women will have their babies in hospital and the majority of midwives will work in hospitals.

Secondly, the rhetoric about doctors needing to 'supervise' midwives is unhelpful. We need to all work together as respectful professionals, knowing when and where to access the expertise of the other.

Thirdly, the current model does not work well, as is asserted by the AMA, when we have: unacceptable outcomes for Indigenous mothers and babies; high rates of unnecessary medical intervention; lack of access to continuity of care by midwives despite evidence supporting its benefits, safety and cost effectiveness; lack of postnatal care; closure of around 120 rural maternity services in the past 10 years; a midwifery workforce shortage (1,800) due to workplace stress and lack of opportunities; rising birth costs affecting government, insurance funds and women; low rates of breastfeeding at six months (34%); increasing rates of perinatal depression and maternal suicide; lack of insurance for midwives.

Finally, it is time to stop the war and start working together to address these issues. It can no longer be about ‘us’ it must be about women.

Dr Hannah Dahlen

Spokesperson for the Australian College of Midwives


Sirs

Dr Capolingua knows full well that the Maternity Services Review is not about homebirths but about increasing choices for women in maternity services.

In terms of her comments about the safety of homebirth, readers should be aware that last year the WA Health Dept commissioned a review of evidence relating to issues of maternity care. This review was carried out by the Women and Infant Research Foundation at King Edward Memorial Hospital in Perth. This review entitled: “Models of Maternity Care: A Review of the Evidence” 3 includes an Evidence Summary Point on page 16. The summary states:

“Planned homebirth with a qualified home birth practitioner is a safe alternative for women determined to be at low obstetric risk by established screening criteria.”

The WA Maternity Services Framework launched last year supports the provision of midwifery-led care for women in WA not only for homebirths but for women who choose to birth in hospital: which is what women in WA want. Support for this at a Federal level is to be welcomed.

Reform in maternity services in Australia is urgently required and, at last, both State and Federal governments have woken up to the fact.

For the sake of women and their families could the AMA not work collaboratively with the government, midwives and consumers to provide maternity services that work rather than seeking to protect their patch?

Debbie Slater

Perth, WA