Hello I have been a silent subscriber (rather than a "lurker") for some time. I am attaching a copy of my email to Life Matters - rather long winded - perhaps a result of being silent for so long. It is reassuring to see that there are so many out there fighting the same fight albeit in slightly different arenas. Sometimes we get overwhelmed by the enormity of the problems but lots of small voices can deliver a pretty loud message. I was on the recently famous "Chunder Bucket Express" which travelled from Cairns to Brisbane to attend a Rally outside Parliament House to protest against the governments neglect of chronic problems in the nursing profession. There were a group of midwives from Maryborough who told us that the birthing unit at Maryborough is to be closed down at the end of this month. This is a tragic tendancy and one we in Mareeba live in fear of. Last month I was in a delegation to the Health Minister when a "Country Cabinet Meeting" was held in Cairns. I presented a similar argument as is contained in my email to Life Matters. I don't feel as though I made a great impression at the time but perhaps one of the peripheral advisers will read what I wrote or follow up some of the references. As more little voices express similar concerns and ideals perhaps we will make a greater impression.
More power to you all Sandra Eales ----- Original Message ----- From: Vernon at Stringybark <[EMAIL PROTECTED]> To: ozmid <[EMAIL PROTECTED]> Sent: Monday, July 15, 2002 10:18 PM Subject: [ozmidwifery] Pls send feedback to Life Matters > Dear all, > > I've been reliably informed that a positive way to encourage the Life > Matters program to give further air time beyond tomorrow's program to > midwifery and consumer issues is for there to be lots of feedback from > listeners expressing interest in/opinions on the issues raised in a given > program. > > Pls send emails to Life Matters <[EMAIL PROTECTED]> or write a > letter after tomorrow's program and encourage others to do the same, > especially pregnant women, mothers and midwives! > > cheers Barb. > > > Dr Barbara Vernon > National President > The Maternity Coalition > PO Box 269 > LYNEHAM ACT 2602 > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
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Senate report into Childbirth Procedures - Rocking The Cradle (page 73) "...the NSW study found that deliveries continue to occur in hospitals without an obstetric unit and will still present unbooked and often in preterm labour. This often occurs in small towns with where the units have been closed because of low numbers of deliveries, lack of support services or proximity to larger hospitals. Without the professional experience of a functioning obstetric and midwifery service, perinatal mortality and morbidity figures tend to be sub-optimal.
This highlights the need to keep small rural obstetric units open and to staff them adequately. Rural women will continue to want care closer to home and have every right to expect a safe, accessible service."
With "rationalisation of services" healthy women lose the benefits of giving birth close to their homes and families. There is increased stress on the family unit if husband and other family members have to travel 50 or 100 km either way to visit the woman. Many women have false starts. ..spurious labour on and off for days...a 100 km trip for check up and reassurance will surely increase the fear and isolation these women feel.
Many women barely make it to the local hospital in time to give birth so if even an extra 30 kms is added to the distance the number of BBAs (born before arrival to hospital) will be greatly increased. This is stressful and uncomfortable for the whole family.
Postnatally the woman will be more likely to leave hospital early in order to close the distance between herself and her family. This has been shown to have a detrimental effect on breastfeeding, adjustment to parenting and postnatal depression.
In country towns the maternity units are an important resource in terms of postnatal care and support for parents in the first few months which are often stressful and fraught with difficulties. There is enormous reassurance for parents in the fact that there is a midwife/lactation consultant (usually known by, and knowing, the mother) in the hospital that they can call on for phone advice or go and see when feeling overwhelmed by either the "normal" experiences or problems encountered in early parenthood.
The maternity units in rural hospitals take on the role of Tresillian or Karitane (parenting) Centres which are available to women in the metropolitan areas. If a mother is not coping with a particularly unsettled babe, or requires a period of care to overcome breastfeeding difficulties or in crisis situation where a mother may need some temporary assistance to cope she is able to come to a familiar environment which is easily accessible and have the support and advice that will enable her to adjust to her parenting role.
Birth is a normal physiological event and the majority of women do not require the services of a specialist obstetrician to see them safely through it. There is plenty of evidence to show that mother and baby do best with midwife care, and with continuity of care.
In terms of safety for mother and baby, and for long term benefits both economic and with regards to the health and well-being of the family we need to ensure that midwifery and obstetric services are maintained in the rural centres.
Rural G.P.s and midwives are very good at identifying the abnormal and referring those cases on to specialist care as necessary.
Rather than send all women to where the obstetrician resides we should be leaving the women close to home and flying the obstetrician in for those rare occasions where his/her services are actually required.
The first and last consideration is safety - of mother, baby and their family and the safety of staff.
The experience of Childbirth is surrounded by fear
fear of death
fear of litigation
fear of unknownThe woman and her family need to be confident in the services provided, that there is sufficiently qualified personnel and resources to assist them in this profoundly important time of life. Equally important is that the woman "feels" safe. She requires more than a verbal /intellectual assurance that she and her baby are safe. She needs to "feel" it. All animals require the same feeling of safety in order to be able to give birth to their young. The profound physical and psychological changes the a pregnant woman undergoes make her extremely vulnerable and she needs to be protected and supported during this time.
Providing continuity of care is very effective way of ensuring that the woman "feels" safe. The organisation of our antenatal clinics and the fact that we have a small team ensures that the woman knows the environment and the people who will be likely to be with her during the birth. This familiarity is a huge comfort to the woman and her family in this exciting but often frightening time. The intimacy that is possible in the small team environment is a significant factor in the satisfaction and safety of both client and staff.What We Need To Do
Provide women with real choices about how and where they give birth - in a small, midwife-led unit, at home, or in a hospital close to home, specialist medical care if required - whichever suits women's individual needs and circumstances.
Offer high quality care that is cost-effective
With current caesarean section rate at >20% and obstetric litigation, the cost of over-medicalised childbirth has never been clearer.
Casemix funding rewards poor practice. More money for more intervention. More money for cracked nipples whereas midwife time invested will prevent cracked nipples and increase breastfeeding success which has enormous health and economic benefits in the long term.
One on one care reduces the needs for intervention such as epidurals and the "cascade of intervention" which often occurs in large obstetric units. Midwife led care is safer for mother and baby as shown in the Roberts study.Employ enough midwives to provide one-to-one care for every woman during labour
The job satisfaction for midwives working in a midwifery model of care is much greater than the experience of working in a large obstetric unit.Encourage women to get to know the midwives who will care for them.
Providing continuity of care is very effective way of ensuring that the woman "feels" safe. The organisation of our antenatal clinics and the fact that we have a small team ensures that the woman knows the environment and the people who will be likely to be with her during the birth. This familiarity is a huge comfort to the woman and her family in this exciting but often frightening time.
The intimacy that is possible in the small team environment is a significant factor in the satisfaction and safety of both client and staff.
By making sure that every woman has a known midwife who she can call with queries and concerns, or by providing 'caseload' care, which means that the same midwife provides care throughout pregnancy and after.Give women and babies the care they need in the first days and weeks after birth
Postnatal care is underfunded, leaving women and their families without the help they need.References
Davidson, M., (2000) The Introduction of a Midwifey Model of care to a Rural Hospital" Conference Paper for the 2000 Queensland DON’s Conference.
Smith, J.P., Ingham, L.H., (1997) "Economic Value of Breastfeeding in Australia" Breastfeeding The Natural Advantage - NMAA International Conference
Senate Community Affairs References Committee. (1999) Rocking the Cradle: A Report into Childbirth Procedures. Canberra. Commonwealth of Australia1999. Available at www.aph.gov.au/senate/committee/clac_ctte/index.htm
National Maternity Action Plan available at www.communitymidwifery.iinet.net.au/nmap.pdf
Roberts, C.L., (2000) "Rates for obstetric intervention among private and public patients in Australia: Population based descriptive study" British Medical Journal. Vol 321 (7254). Pp137-141.
..."Continuity of Care: Does it make a difference to Women's views and experiences of maternity care?" Darcy M. Brown S. Bruinsma F. (2001) Centre for the Study of Mother's and Children's Health, La Trobe University.
NHMRC Options for effective care in childbirth 1996
NHMRC. Review of services offered by midwives 1998Model of Care at Mareeba District Hospital
This is a brief description of the Midwifery Model of Care which has developed over a number of years at Mareeba District Hospital. We are a rural hospital with an annual birth rate of approx 200. We have a 13 bed unit for maternity and paediatrics, including 3 family rooms which are furnished with queen sized beds to enable partners or significant others to stay, as well as 2 birth suites and an outpatient consultation room.Booking In
Initial presentation, either self referred or by referral from GP, is to Booking -in Clinic which is held on Tuesday is usually done by the CNC. She is then allocated to one of four midwives clinics.Antenatal Clinics
The Green clinic is a Monday afternoon/evening clinic which is more convenient for some clients for work or childcare reasons. The Yellow, White and Gold clinics are held on Tuesday, Wednesday and Friday respectively. This organisation gives the women choice of midwife, day and time as well continuity of care which is invaluable in terms of efficiency and comfort. Small numbers through each clinic allow an intimacy not otherwise obtainable. Midwives order all routine blood tests and review all pathology results.
A Doctors clinic is held on Tuesday morning for referrals from the midwives clinics. All women are seen once by the doctor for routine physical examination and after that only if there is a problem requiring medical consultation.Case Conference
A case conference run by the CNC is held every second Wednesday morning 0800-0900 hrs and is attended by all doctors and whichever midwives are available. All new bookings, all clients of 36/40 gestation as well as any significant "high risk" pregnancies are discussed. Management of complex cases is discussed and planned. In this way everyone likely to be involved in the care is kept aware of what is going on. This collaborative approach promotes the good relationship between doctors and midwives which is so necessary for the delivery of quality care. Good open communication and respect is necessary as well as clear role delineation and practice guidelines. All clinics are held within the maternity unit rather than the OPD so the women familiar become with the faces and environment which they will encounter when they come in in labour. This is a subtle but significant advantage to the women and the midwives.Antenatal Classes
A childbirth education programme is conducted by the midwives in the maternity unit. One midwife conducts a 6 week education programme which is attended by up to 10 couples. Attendance is booked usually at booking-in so the midwife knows who is coming and may make phone contact prior to class if desired.Birthing
Midwives are responsible for the management of all uncomplicated labours and births. Doctors do not routinely attend uncomplicated births.Students Experience
Whilst they do not get large numbers of deliveries most have a more valuable experience because it is wholistic. In any two week period they may only get to be involved in a couple of births but they have usually previously met that woman in the antenatal clinics and they also have the opportunity to care for her postnatally. This is a much more powerful learning experience than is possible with the fragmented care that occurs in the tertiary centres. It is also a lot less intimidating for the woman. Students and clients benefit from the opportunity they are given to establish a relationship.Postnatal Care
Length of stay is determined by the needs of the woman. Family rooms allow the partner to stay with mother and baby. This assists with the transition into parenthood for both parents.
Drop-in or telephone service for breastfeeding and other parenting support and advice.
Women referred from Cairns Base Hospital for establishment of breastfeeding after NICU.
Women referred to Lactation Consultants from Community Health Nurse, ABA Counsellor or GPs.Thank you for giving space to this important issue on your program as there are many changes occurring at this time in the provision of maternity services. We need to ensure that we get the system right for families of the future. We need to build a system that will enable families to come through the experience of childbirth with joy and empowerment rather than fear, dislocation and unnecessary physical and psychological trauma.
Yours sincerely
Sandra Eales
