May 06, 2004

How to reduce the epidural rate

Tuesday May 4, 2004

The Perth event today was another winner. The group was touched by the emotion of the videos and enthused and inspired by the presentations and workshop sessions. Many of the midwives here in the West are very stressed from fighting running battles with obstetricians, constant uncertainty about the Community Midwifery Program (CMP) and lack of support from many hospital administrations. They are doing a sterling job, despite these problems, and have shown the rest of Australia a number of innovative ways of working, especially through the CMP.

I was able to catch up with a group of midwives from Geraldton, a major centre north of Perth. Last year I was asked to present an Active Birth workshop for their staff, which I was delighted to do. They were a committed bunch, already well on the way to providing an excellent midwifery service and just needed a little encouragement and a few more ideas. Yesterday I had some great feedback. After my visit, the group consolidated their own goals and immediately began offering a less interventionist approach to supporting labouring women. They don’t have a pool or tub, but encouraged the use of hot packs and hot wet towels as substitutes.

I was told that their epidural rate had dropped dramatically, to the point that the anaesthetist had enquired if someone else was doing the epidurals, as he wasn’t being called any more. The midwives were thrilled to be able to tell him that women weren’t asking for epidurals, and his services were rarely needed. Their use of pethidine has also dropped dramatically and women are receiving real midwifery care instead. The midwives were well supported by their obstetrician, who encouraged VBAC and valued midwifery.

At one point the midwives asked if they could have some funding for further staff development. They were told that “they had blown the entire budget on my workshop (I am not all that expensive - their budgets are really quite small!). In response, the Clinical Midwifery Consultant totted up the money the hospital had saved from the drop in drug use and epidurals, to prove how valuable an investment this workshop had been. Even though the savings had been substantial, administration would not award them more money is that financial year for staff development - a very short sighted move.

Meanwhile, their wonderful obstetrician was poached by the main hospital in Perth. Being a rural area it is hard to get doctors, and they have had to put up with a series of consultants being flown in for a few days at a time while a permanent obstetrician could be recruited. Last month, as a result of this terrible policy, their caesarean birth rate shot up from the 9% they had achieved for years, to an alarming 48%! I am told that they are hopeful than a new obstetrician from the UK will be appointed and that their midwifery model will be supported again, with a drop back to outstanding low level of intervention they enjoyed before.

This example proves what can be done when a committed bunch of midwives share a vision of natural birth and work together to support women achieve their dreams. Geraldton is now investigating other ways for furthering these outstanding results through the introduction of new midwifery programs. A new maternity unit is to be built and it will have a pool available. They are an inspiration to us all and it will be good to hear of their progress in maintaining and developing what is clearly an outstanding example of midwifery care.

Posted by andrea at May 06, 2004 10:47 AM