Should women in Queensland be worried about maternity care?
In the last couple months, the Australian Medical Association’s Queensland branch has been quite damning of maternity care in this state, in what seemingly is credible public statements they’ve made (after all- they are doctors, who are meant to be reasonably intelligent, right?!?). The Queensland President, Dr Chris Zappala has been spouting off with unfounded recommendations on how our maternity sector should be:
AMAQ raises concerns over midwife led births
Now, just for some clarity, Chris Zappala isn’t even remotely qualified in maternity care- he’s a sleep specialist! What’s more, the “studies” he consistently refers to are not high quality evidence, haven’t been peer reviewed, nor even cited by him.
This is absolutely a load of garbage, to put it mildly. Obstetricians have never been sidelined, there are very clear scopes of practice for midwives, and obstetricians, in fact midwives have consultation and referral guidelines that are used routinely for every birth, when necessary.
Medical lobbying such as this has continued to pressure government into bowing down to fanciful claims, without a thought for women and baby’s welfare- physically, mentally and emotionally. There is increasing disparity between our maternity care, and other models of care around the world, which are evidence based.
I personally don’t think it’s any coincidence AMAQ are ramping up their lobbying and media stunts in Queensland- we know increasingly women are leaving private obstetric care- and a recent publication reported women are in favour of midwife led care:
…..Transparent much? Private obstetricians are worried about their back pockets.
The Lancet medical journal articles into national maternity care have identified Australia as falling into a situation where they provide “too much, too soon” (an over-medicalised model of care), leading to worse outcomes for mothers and babies (Miller, et al. 2016). Not only do we have a rising intervention rate, without better outcomes, our current maternity system is cost ineffective, with perversive incentives for over-medicalised care- just look at a vaginal birth cost of around $9000, and a cesarean birth costing around $14000.
Evidence based care is midwifery continuity of care, which has been widely studied, and is practiced countries such as New Zealand. A review of midwifery continuity of care models in the Cochrane Library included 16 trials involving over 17,000 women from around the world including trials from Australia. Women who had continuity of midwifery care were less likely to need epidurals or to use other drugs for pain relief in labour or have an instrumental birth. Women in the midwifery care groups were also more likely to have a normal birth, more likely to feel in control during labour and birth, and commenced breastfeeding earlier than women who had other models of care (Sandall, Soltani, Gates, & Devane, 2016).
We need a maternity model similar to New Zealand- women are allocated their funding for birth, and every woman, regardless of risk, demographics, age or location is allocated a known midwife as her Lead Maternity Carer.
Less than 10% of Australian women can access midwifery continuity of care (known midwife for pregnancy, birth and postnatal care) (Dawson et al., 2015). Furthermore, almost 1/3 are experiencing postnatal depression and over 14% experiencing PTSD as a result of birth (Boorman, Devilly, Gamble, Creedy, & Fenwich, 2014). There are increasing rates of intervention, with our current caesarean rate of 33% (public) and 40% (private) one of the highest in the western world (Shaw, et al., 2016). The World Health Organisation recommends between 10-15%.
Midwives Australia spokesperson, Liz Wilkes has responded to AMAQ's recent "recommendations" for Queensland's maternity sector:
It’s a shame AMAQ is using women’s birthing bodies for their political gain, but alas, this has always been the basis of the patriarchy of maternity care. Truth be known- it’s going to change. Women won’t be told what to think, how to choose care, or to ignore high-quality peer reviewed research. This isn’t about a turf-war, it’s about woman-centred care- which the AMAQ really needs to be reminded of this.
So, for the record. You're as safe as you've been for the last couple decades at least in this current maternity setting? Could it improve? Of course, but the answer certainly isn't in turning our public maternity system into something modelled on the private system, which will further limit women's choice and result in further intervention and poor outcomes.
Boorman, R., Devilly, G., Gamble, J., Creedy, D., & Fenwich, J. (2014). Childbirth and criteria for traumatic events. Midwifery , 255-262.
Miller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D., et al. (2016). Beyond too little, too late and too much, too soon: a pathway toward evidence-based, respectful maternity care worldwide. The Lancet.
Sandall, J., Soltani, H., Gates, S. S., & Devane, D. (2016, April 28). Midwife-led Continuity Models versus other models of care for childbearing women. From Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004667.pub5/full
Shaw, D., Guise, J., Shah, N., Gemzell-Danielsson, K., Joseph, K., Levy, B., et al. (2016). Drivers of maternity care in high-income countries: can health systems support women-centred care? Maternal Health 4. The Lancet.