http://theage.com.au/articles/2004/06/21/1087669915696.html
Maternity services to get overhaul
Health Reporter
The new model, to be announced today, will encourage more women with low-risk pregnancies to have their babies using midwives rather than obstetricians. If complications arise, the woman would be transferred to the obstetric care stream, although in some cases this may not be located at the same hospital.
Health Minister Bronwyn Pike said the main reason for the change was that many women sought the option. But she also acknowledged that the shortage of obstetricians and anaesthetists was part of the equation. "Certainly workforce is an issue, but it's not the driving force for this," she said.
Ms Pike was concerned by rising levels of intervention in childbirth, particularly by elective caesarean section.
"I'm worried about the plethora of stories in women's magazines that seem to indicate that women are choosing a caesarean section, when it's not medically required, for cosmetic reasons," she said.
Elective caesarean rates in Victoria have jumped from 11.5 per cent of births in 1999 to 14.1 per cent in 2002. In public hospitals in 2002, 11.6 per cent of births were by elective caesarean, and 63 per cent of babies were born in public hospitals.
For most hospitals that chose to adopt the new model, she said, the obstetric and midwifery services would be at the same location.
"There will be, however, the opportunity for some services which have good access to a tertiary service to offer only the midwifery model of care," she said.
One of those earmarked for this model would be Williamstown Hospital, where women who developed complications would be transferred to Sunshine Hospital for obstetric care.
Jeremy Oats, chairman of the maternity services advisory committee and director of women's services at the Royal Women's Hospital, said details had yet to be finalised. "What we need to make sure is that it can deliver safe, optimal outcomes for women who choose that model of care," Professor Oats said.
He believed the benefits of the new system would be in best using the skills available - obstetricians and midwives.
But there is also a shortage of midwives, and the profession is ageing, which could be a problem. As part of the changes, the Government has allocated $450,000 for training doctors and midwives for the new system.
Professor Oats said rural services, which have been struggling under closures of maternity units, would also benefit from the new system, allowing GPs with obstetric skills and midwives to improve their expertise.
Opposition health spokesman David Davis supported midwifery care, but he accused the Government of using the new model as "a cover for further cuts and closure in maternity across Victoria".
Since 1993, 27 hospitals have ended their obstetrics services. But Ms Pike said the new model meant maternity services were more likely to stay open, protecting them from closure because of a shortage of specialists.
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