No Subject

[Tony Payne]

Dear List,   I have advised Bev. L. Beech (AIMS UK) about the senate enquiry and have posted her response for your interest:   Dear Robin, Thanks for the fax, I don't think I have been so excited by a fax in years.  This enquiry is a wonderful development and an opportunity for consumers to affect policy.  I see nothing in their terms of reference, however, which suggests that they will be basing their findings on scientific evidence.  This is very important, because if they do not their report will be immediately dismissed by the medical profession as a result of consumer pressure and unscientific.  The Winterton Report was based on scientific evidence and they ignored almost all of the evidence from the Royal College of Obstetricians and Gynaecologists because it was based on opinion and they produced no scientific evidence to support their position.  Even so, the first jibe from the medical profession was that Winterton was irrelevant because it was not based on scientific evidence, they stopped saying that in public when the consumers leapt down their throats and pointed out that they clearly could not have read the report because it was entirely based on scientific evidence.  So, I would suggest you write and ask the enquiry if they are going to base their findings on scientific evidence and then be sure to put as many references as possible in your submission. I am not clear whether you are an AIMS Australia member or not, if not I would suggest you contact Astrid Wurfl, AIMS Vice President, and if she is not already aware of what is going on alert her to this enquiry.  Her address is PO Box 420, Redhill, QLD 4059, tel: 07-3376-4355.  The more consumer groups that submit evidence the better.  A very encouraging development is that this enquiry appears to be undertaken by lay people.  Who are the Committee's advisers?  The Winterton Committee had an obstetrician, a midwife, a GP, a statistician, a paediatrician and a lay person - all of whom were acceptable to both consumers and respected within the profession.  In other words, they did not have a rabid medical man in their midst, they chose the more thinking members of the profession. Our submission to the Winterton Committee was called "Childbirth Care - Users' Views"  Almost all of what we said in that document is still relevant today, so I shall send you a copy and feel free to use as much of it as you wish and if you need any scientific papers to back what you are saying just let me know and I will do my best to find them. Re. your questionnaire.  Yes you should name all the hospitals and I would suggest you also print their response where appropriate.  It will reveal just how devious they are.  As long as you stick to the facts I do not see how they can attack you.  Statistics not released is a powerful statement because it makes it clear that they are hiding something, and I have no doubt that they will huff and puff, but too bad.  Any threats can be countered with a letter which says:  I am most concerned if the information I published is inaccurate (that is the usual allegation) if you would like to detail why this is so I would be more than willling to print your letter.  This approach by me has always produced silence. Also, re the enquiry.  I have been battling for the last ten years or so for hospitals to present their statistics in a way that one can determine how many women have normal births.  All the hospital statistics here quote normal births, but this just means that the baby was born vaginally without forceps or ventouse.  It means that although the hospitals give statistics for artificial rupture of membranes, induction, acceleration, epidural anaesthesia, episiotomy a woman could have each one of these procedures (including continuous electronic fetal monitoring for which few hospitals give statistics) and still be counted as having a normal birth.  So any assessment of normal birth can only be guesswork.  Nonetheless, it is clear from our statistics that in the large centralised maternity units less than 10% of women have normal births by our definition.  I would suggest that you use the argument that it is important to determine how many women have normal births because the majority of consumers expect to have a normal birth and if they are to choose a hospital which would give them the best chance of achieving this they have to have the statistics presented in a manner by which they can make this assessment.  Therefore, all statistics should have a separate box which on data entry should require the staff to separately note whether the woman has had artificial rupture of membranes, induction, acceleration, epidural anaesthesia, episiotomy and continuous electronic fetal monitoring.  If she has had any one of these interventions they should enter obstetric delivery, if they have none the entry should be normal birth. If you can get the committee to adopt this you will make a huge difference because, for the first time, one will be able to judge how many women actually achieve a normal birth and once the consumers understand how rare this is in large obstetric units they may well vote with their feet. Which reminds me, you will also need a statement of what a normal birth is:  a normal birth follows spontaneous onset of labour, from the 38-42 week of pregnancy, where the labour progresses unaugmented and where the baby is born by the expulsive efforts of the mother. Finally, sorry this is such a long email but I hope it will be of use.  Your fax was quite amazing, three inches from the bottom of the last page the machine ran out of paper!  Usually, when it gets near the bottom of the roll the machine jams, so the Gods were smiling upon us I suspect.  Keep up the good work, Yours Beverley.