January 19, 2004

Let's try not to give up hope....

This last weekend spent in Wollongong was very enlightening. The local Area Health Service operates Wollongong Hospital and Shellharbour Hospital as a single entity spread over the two campuses ( Shellharbour is about 25 minutes drive from Wollongong). It has operated a very obstetrically dominated maternity service for many years, especially after the Birth Centre at Bulli (about 30 minutes away) and smaller units at Kiama and Port Kembla were closed to consolidate obstetric care in one centre. The Birth Centre at Wollongong was also closed not long ago as part of the “renovation” of the hospital.

Shellharbour maternity unit has been under a cloud for some time. It has always had a midwifery model of care valued by the local community, but around a year ago, the obstetricians announced that they would no longer travel to Shellharbour and the Region’s Administrators announced the maternity service would therefore have to close down.

An opportunity was seen for the establishment of a midwifery unit, along the lines recommended in the NMAP Report. Representations were made to the relevant authorities and the State Government indicated that this would be a pilot region for the new models of midwifery care. The midwives were very excited about the prospect and began planning. Then the obstetricians reared their ugly heads again and announced they would not provide any backup for the new unit and the local Regional boffins bowed to the pressure and said the Shellharbour unit would operate as a midwifery unit but only offering pre and post natal care - the women would have to give birth in Wollongong itself.

Having fought long and hard the local midwives are feeling very demoralised. Nine left Wollongong at Christmas with three more to leave soon - they cannot tolerate the high levels of obstetric intervention and the lack of alternatives for women and midwives any longer. This is a huge blow to those who are left and places more pressures on them. The hospital is seeking to fill the vacancies created by hiring enrolled nurses - a recipe for lowered standards of care and higher potential for “incidents” around patient safety.

This morning I logged onto the ozmidwifery list and read that other smaller units around Australia are also being closed - every State is seeking to centralise maternity services in larger and larger hospitals - partly because of the lack of staff, and partly because the obstetricians won’t work in smaller hospitals where they might not be able to see a range of clients (to make their work more interesting and lucrative). The disappointment and depression amongst midwives in Australia is almost palpable, and it is hard for even me to keep a positive outlook.

Just when I was feeling a bit low, I had a call from my good friend Lynne Staff at Selangor Private Hospital in Nambour, Queensland. In a state not known for its progressive ideas, this maternity service stands like a beacon in a sea of mediocrity. Their outcomes are the best in the country and their dedication to woman centred care is exemplary. They don’t just talk about it - they practice it every day.

Lynne told me that yesterday they had another vaginal breech birth and today they’ve assisted at a vaginal twin birth. These are norms for their unit but are almost unheard of elsewhere. This good news has cheered me - as I said to Lynne it may be that in the future midwives will need to travel to Selangor to get some practical experience of these basic midwifery skills....

Meanwhile, Lynne and a colleague who also does some shifts as Selangor, Vicki Chan, are scheduled to speak at the Midwifery Intensives program that will be touring Australia in May. I can’t help feeling that this event is very timely and that we will need to keep them coming so that midwives have a chance to maintain their confidence and competence at managing normal births. It is all very well to talk about “keeping birth normal” but midwives need to know the practicalities of making this work. This program should help.

Meanwhile, I’ll try not to give up hope of every seeing midwifery models of care rolled out around the country.......

Posted by andrea at January 19, 2004 03:04 PM