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
