----- Original Message -----
Sent: Wednesday, April 17, 2002 8:23
PM
Subject: support what you say
Hi, just caught the quality viewing on ACA again tonight and
thought I would write a little letter to Mudge for clarification on what he
said regarding the early discharge and home help program offered by the Lyle
Mac here in Adelaide. I have pasted it below if anyone is
interested. this man has made some pretty out there comments before so I
thought I would take him up on it this time.
For those who missed it he said that it would be
putting mothers at risk of PPD and babies at risk of gastro.....pretty poor
arguments but he was very condescending to the program which I believe is
unfounded.
cheers
Jo
Dear Dr Mudge,
I watched with interest your comments on A Current
Affair last night regarding the early discharge program being trailed at the
LMHS.
Your criticism of the early discharge program included
the risk of post partum depression, which caught my attention. I would be very grateful if you
could explain your reasoning for listing this as a risk in the context of this
program? You did not give clear
reasoning as to why a healthy mother after a normal pregnancy and birth, with
a healthy baby, being given the option to choose to go home early and have
home help would be at increased risk of PPD. Surely the benefits of a support
person whom offers a helping hand, some advice based on recent up to date
study (if only a comprehensive 6 months), and peer support, coupled with
visits from trained midwives, would in fact lower the risks of PPD? Could you explain to me the difference
in a pilot program of this type and the home help offered to private patients
through their insurance companies?
Factors such as a caesarean birth; instrumental birth;
the constant interruptions from well meaning staff within the public post
natal wards; separation from partner and other children before leaving
hospital are stressors that can have a negative psychological impact on some
new mothers resulting in PPD.
Contributing factors once going home include: isolation, sleep
disruption, increased workload with older children and so forth. Almost all of these things can be
elevated if not eliminated by early discharge and a support network.
The option of early discharge is something that a
growing number of women are seeking, and it is being catered for some with
private health insurance, so why not those within the public sector. Those mothers whom are confident and
competent to go home early should be supported in doing so. As Prof. Dekker stated, becoming a
parent is NOT a medical illness.
For some mothers there are problems, no doubt, but these are not the
women under discussion.
I feel that perhaps when making this public statement,
you were not taking into account the socio-economic state of a large portion
of women who birth at the LMHS. I
feel that limited numbers of mothers would have access to the private health
insurance benefits of home help.
I agree
that for those who are at greater risk of an adverse psychological state in
the post partum that an early discharged program may not be suitable. However did you take into account that
for those women who do births within the public system and stay for the three
to five day period are often subjected to over worked staff and thus reduced
quality of care? These women are
at a possible greater risk of post partum depression for their emotional needs
are sometimes overlooked, misunderstood or even ignored? The benefits of one on one contact,
continuity of care, in this form of �mother help� could include an earlier
detection of depression or even avoidance of
PPD.
If my memory serves me correct, you voiced some
reservations about the quality of service that the young women were
offering? Can you state that the
quality of care offered by insurance companies with the home help benefit is
adequate? I understand that this
was not the topic of discussion �types of home help care that is available-
but I find it interesting the level of criticism you displayed towards this
program?
I am interested in what level of training in women�s
mental health that obstetrics includes? I have written to the RANZCOG for
clarification on this. I would also be interested in what
strategies the AMA, and indeed your own practice, have been implemented to
lower the incident of PPD. I am
shocked at how little is offered to women who are at risk of PPD and the
limited knowledge that obstetricians have on those who are at greater risk. (I
say this with confidence as I have been invited on more than one occasion to
speak to the obstetric staff at Flinders Medical centre and this is a topic
that is often discussed. I
have also been an advisory to the Royal Women�s Hospital in Melbourne on the
emotional impact of caesarean birth and vbac.)
This is not intended to be a personal attack on
you. I am merely concerned that
the arguments you stated in a public forum were not evidenced based and would
like you to support what you said.
I have forwarded this letter on to A Current Affair and Prof. Dekker
and the AMA as I believe that they too would be interested in further
understanding the basis for your criticism.
Thank you for your time and look forward to reading
the information you can no doubt supply to support your
statement.
Thank you.
Jo Bainbridge
founding member CARES
SA
email: [EMAIL PROTECTED]
phone: 08
8365 7059
birth with trust, faith &
love...
