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Midwives and obstetricians at loggerheads again in Queensland

Over the past two weeks there has been an amazing media stoush between Dr Molloy, the past President of the Queensland State Branch of the Australian Medical Association and midwives, primarily those working in the Birth Centre at the Royal Brisbane Women’s Hospital. Dr Molloy is known as the most vocal Australian proponent of caesarean births for all women and reportedly has a 100% caesarean section rate in his private practice.

A bit of background - this is the only Birth Centre in Brisbane, Queensland, the last state to get such a unit. The local obstetricians have fought the development of midwifery services in this State over many years and have waged an active campaign to discredit midwives, especially those who have offered home birth services. This “witch hunt” has been well documented and has given rise to many clashes in the media and some colourful public protests, such as the time a washing line of baby’s clothes was strung across the front of the Government House as part of a protest march.

Recently, Dr Molloy issued a statement that the Birth Centre at the RBHW was a “killing field” and the centre was being very poorly run, placing mothers and babies at risk. This was hotly refuted, and after pressure was applied (no doubt by his colleagues) he retracted the statement, saying that he was “just repeating what others were saying”.

Eventually, a Press Release came out from the State Branch of the Australian College of Midwives, following the release of a report into the running of the Birth Centre. It is worth reproducing the Press Release here, as it highlights very clearly the antics that go on behind the scenes when the medical establishment and hospitals collude to restrict options for birthing women. Jenny Gamble is a midwife (with a PhD), and is State President of ACMI in Queensland.

The report highlights “That there were widespread system issues and a culture that is actively unsupportive of a midwife-led service that meets consumer expectations and demands”. This has been occurring despite there being significant unmet consumer demand for continuity of care by midwives with 3 times as many women being turned away from the Birth Centre than are accepted.

Problems highlighted by the report include inadequate allocation of resources to the Birth Centre, lack of support by management for evidence based clinical guidelines and policies, and lack of commitment within the wider hospital to the collaborative approach necessary to ensure the Birth Centre is able to provide the best possible care to all women.

“Birth Centre Midwives have been alerting management for years to the lack of collegiality and respect from some obstetricians and trainees towards Birth Centre midwives and the women they care for” Dr Gamble said. “The College understands that formal complaints about some obstetricians refusing to treat a labouring woman referred to them by Birth Centre midwives have never been responded to.”

“We call on Queensland Health to ensure the recommendations are fully implemented” Dr Gamble said, “Midwives at the Birth Centre have been calling for many of the recommendations to be implemented for many years, but have been repeatedly ignored” “For example, midwives have been keen to provide care to women from early in pregnancy until a month after the baby is born as the Report recommends, but have been prevented from doing so.” said Dr Gamble. ”Midwives have also been urging management to adopt evidence based policies and guidelines, like national referral guidelines, without success.”

Lack of management transparency is another problem flagged in the report. “At the moment it looks like implementation of the recommendations will be managed unaccountably by RBWH Executive, when it is on their watch that these problems have persisted” Dr Gamble said.

“Only with a transparent and consultative process for implementation, that includes representatives of consumers, Birth Centre midwives, obstetricians and Department of Health officials--not just senior RBWH management--will the public be able to have confidence that we’re not just in for more of the same” Dr Gamble said. “The Report has confirmed that the service at the Birth Centre is safe, cost effective and popular with women.”

“In line with Dr Cherrell Hirst’s recent recommendations for state-wide maternity services [the recently released State Government Enquiry into Obstetric Services in Queensland- ed], it’s time the Birth Centre at the Royal was properly resourced, supported and respected so that women who seek continuity of care from midwife can be confident of the highest standards of care whether or not they experience a straight forward labour and birth” Dr Gamble said.

The battle goes on.....

Posted by andrea at June 08, 2005 06:24 PM