Fw: childbirth and maternity services

[Elizabeth McAlpine]

----- Original Message ----- From: Elizabeth McAlpine To: [EMAIL PROTECTED] Sent: Tuesday, July 24, 2001 1:19 PM Subject: childbirth and maternity services Dear Mark Robinson & editor,   I refer to the article, ‘Birth Services in crisis as high fees force out doctor’, July 24th,2001.    ‘The cost of professional indemnity insurance forces an obstetrician to cease practice, an AMA survey of 292 specialists reveals that more than half were thinking of quitting or have already done so’.    The insurance issue is a disgrace, but why are premiums so high and why do they vary so much?? Could it be how obstetricians practice?  Australia has one of the highest rates of caesarian sections and inductions in the developed world.  Obstetricians practice defensive obstetrics and intervene far too much in normal physiological birth.   The fear of litigation causes many obstetricians to decline to help midwives in their independent midwifery practice.   However, independent midwifery practice is now eliminated due to the withdrawal of professional indemnity insurance because “the area of childbirth is highly litigious”.    This is true for obstetrics, but not for midwifery, and obstetrics has caused the downfall of independent midwifery.   Maternity services are in a sorry state in Australia, with women having almost no choice in where or how they birth their babies. Over 80% of women can birth normally, and the most suitable care provider, as recommended by the WHO and supported by research evidence, is the midwife.  The role of the midwife is as the guardian of normal birth; to protect, guard, guide, and, most importantly, not to disturb.  Giving birth is a physiological process and obstetricians have to learn not to disturb it.   They have to learn that women need to be consulted about where and how they birth, and with discussions of interventionist practices and risks to include evidence based research.   Litigation often results from the woman’s unanswered questions – why something happened and what caused it? Obstetricians are required to provide advice and support to midwives if required, during the care of these women, and for the 20% of women unable to achieve normal birth, or at high risk due to disease or conditions peculiar to pregnancy.   Their high skill training makes it an absurdity to deal with normal, healthy, low risk women, and their various commitments make it impossible for them to be with each woman during childbirth.   The senate report, ‘Rocking the Cradle’, 1999, made many recommendations regarding changes in childbirth. One of them was the recommendation to establish an independent inquiry into medical indemnity and litigation, including the impact of litigation and indemnity on the provision and practice of obstetric services.   It is high time the government took action and resolved this issue of professional indemnity insurance.   New Zealand did it by way of a ‘no-fault’ clause, which provides for disability when required, without recourse to litigation.     Yours sincerely,   Elizabeth McAlpine 24th July, 2001