The Politics Of Childbirth

Newcastle Herald

Tuesday June 21, 2005

LEADER

GIVING birth is the most natural thing in the world. Sometimes. The fact that things can and do go wrong in a minority of cases puts obstetrics and midwifery among the most potentially troublesome areas of medicine and nursing.

In recent times the rising incidence of women suing obstetricians has led to those specialists being subjected to very high indemnity insurance premiums. This has not surprisingly led to an increase in the tendency of doctors to intervene in births, with the rate of caesarean sections in particular increasing.

One consequence of these trends has been to intensify the long-running debate between those who support a highly medicalised model of childbirth and those who argue for more natural methods to prevail.

At its worst, this debate has led to some doctors being accused of profiting by over-servicing and unnecessarily intervening in normal childbirth, while some midwives are portrayed as ideologically hidebound in their determination to exclude doctors, even when their presence is needed.

Health administrators seeking cash savings can complicate the picture further when trying to minimise the role of expensive specialists in childbirth.

In the case of the soon-to-open midwife-operated birthing centre at Belmont Hospital, the withdrawal of obstetricians, apparently partly driven by concerns at clients' access to specialists, is deeply troubling.

Such dislocation should be preventable. At various times in relatively recent history the Hunter has been cited as a model of co-operation between midwives and specialists. Accredited midwives have worked hand-in-glove with sympathetic doctors who have recognised that the vast majority of births are low-risk and can be handled cheaply and safely with minimal medical supervision.

Cases where complications arose have been quickly and effectively dealt with as soon as well-trained midwives recognised signs of trouble, providing patients with the best features of both models of care.

With goodwill on all sides there is no reason why progress made in the past should be sacrificed. Peace talks between all the parties are urgently required.

IT seems a little unfair of those critics of the NSW Government who want P-plate drivers out of powerful cars to now complain of the $23 fee such drivers will have to pay for exemptions to the impending ban.

P-platers who can prove they need to drive a high-powered car for work or bona fide family reasons will be able to secure the exemption for specified vehicles only. Some critics have called the application fee a disincentive. Surely that's the point. If obtaining exemptions was allowed to be too cheap and simple, or if a single exemption was allowed to apply to any car, the ban may as well not exist. As things stand, the Roads and Traffic Authority will have to be on its mettle to ensure the system for providing exemptions is not abused. For the scrutiny involved in making the system work effectively, $23 seems a modest application fee.