Upper Hunter Mums On Track To Birth Tragedy

Newcastle Herald

Tuesday August 22, 2006

Shari Bonnette

Midwives could solve the "obstetric crisis", says Shari Bonnette.

IT is only a matter of time before a woman or her baby dies during childbirth at the side of the road, considering the lack of maternity care in regions of the Upper Hunter.

Women of the Upper Hunter endure significant danger and injustice when it comes to having a baby.

Being pregnant and living in Merriwa means travelling about 1500 kilometres just for antenatal care (a standard 10 visits) with a GP in either Scone or Muswellbrook.

Despite having a public hospital, Merriwa has not had a birthing service for the past 15 years. Taking into account rising fuel costs in the bush, travel time and the difficulty in taking other children with them to these appointments, rural families suffer significant hardship, all before their baby is born.

To give birth women must travel dangerous roads, dodging kangaroos and other wildlife to access this most basic of primary health care.

As a consequence, some women don't make it to Scone or Muswellbrook hospital and give birth at the side of the road.

This current state of birthing service in the bush is not dissimilar to the developing world.

Consistent with this is the regular cry of "obstetric crisis" in the bush.

The Royal Australian and New Zealand College of Gynaecology indicates that the service provision requirement for obstetricians in rural areas to the female population of childbearing age is 1:15,000.

With a population of about 10,000 women of childbearing age and 6.5 full-time equivalent GPs with obstetric training, the recommendation by the college means there are more than adequate GPs to provide care to women of childbearing age in the Upper Hunter.

And yet, the Upper Hunter GPs struggle because their workload includes sick people and healthy pregnant women.

On average it can take up to one week to gain a standard appointment at a local medical practice, with some women forced to wait 18 weeks into their pregnancy before they can get their first antenatal appointment with a GP.

The solution is to engage specialists in normal maternity care, experts who are registered and educated to provide pregnancy, birth and postnatal care midwives.

But midwives working in the Upper Hunter and in the majority of the region's hospitals are prevented from working the way they were educated and registered to, because maternity services are controlled by the vested interest of medical practitioners.

The health bureaucracy supports this by promoting the personal interest of doctors ahead of families, even though current NSW Health policy and worldwide evidence-based research states that the best-practice maternity care is where a woman receives the care of a known midwife.

Yet little has been done to establish one-to-one midwifery care. Seventy-five to 80 per cent of pregnancies and births in Australia are normal. Midwives are the most appropriate carers for these women.

Central to midwifery is the detection of potential and actual complications and appropriate referral to medical treatment. This is best-practice maternity care.

One-to-one midwifery services, like the one at Belmont, provide women with the personalised care of a midwife during pregnancy, childbirth and the postpartum period. This relationship between the midwife and the mother develops during the pregnancy, with visits of up to one hour depending on the mother's needs.

There is no reason why a similar service cannot be provided throughout the Upper Hunter.

Currently the maternal and child health nurse provides an outreach service to families throughout the Upper Hunter.

This same arrangement could be happening with a midwife, providing a continuum of maternity care.

Importantly, midwives could also reduce the unnecessary workload of GPs, making rural medicine more attractive and sustainable.

Midwives would reduce the number of women receiving little or no antenatal care. Failure to attend antenatal care is considered by the Department of Community Services as a reportable offence, yet the Hunter New England Health service refuses to support one-to-one midwifery as a safe model of care throughout the Upper Hunter.

So next time you hear of an "obstetric crisis" in the bush, think again.

Dismiss the spin created by doctors' interest groups that are established to promote the pay and conditions of their members.

One-to-one midwifery is the solution to providing safe and sustainable maternity care to most Upper Hunter families and across Australia.

Shari Bonnette is convenor of Upper Hunter Birth Choice.