Tuesday, November 18, 2008


The Review by federal Health Minister Nicola Roxon has attracted an unprecedented number of responses. Maternity services are important to our society!

Victorian government’s policy Future Directions for Victoria’s Maternity Services (2004) is the framework that will guide developments over the ensuing 5-10 years. The policy seeks to “work towards quality birthing services where providers have a multidisciplinary approach and where women are informed and have choices.”

The current mix of federal and state funding for maternity care restricts a woman’s access to care by a known midwife of her choice, and protects a monopoly of doctors as the only providers of maternity care. Birth is not an illness, yet public funding for maternity care, as well as private health insurance, fragment the care into medical items within schedules.

What is the state of maternity services in Victoria today?

1. Choice of midwife led primary care is available to some women – see Attachment 1 ‘Having a baby in Victoria’ below.

2. Detailed information on hospitals and number of births is available from Vic Perinatal Data Collection Unit (PDCU) perinatal.data@dhs.vic.gov.au

Attached copies from the PDCU 2007 report Hospital Profile of Maternal and Perinatal Data (attached to this blog as photographs - not particularly good quality, but I can't see how to link a scanned page to this blog!)

• P20 Onset of labour for women who gave birth 2006, with comparison of data for public hospital, private hospital, and homebirth
• P21 Epidural/spinal analgesia in labour primiparae and multiparae- comparison of data for public hospital, private hospital, and homebirth
• P22 Intrapartum analgesia
• P22 Type of birth
• P23 spontaneous vaginal births, forceps births, vacuum births - comparison of data for public hospital, private hospital, and homebirth
• P42-43 graphs of public and private data for maternal age group, maternal postnatal length of stay, type of labour, and type of birth

3. Care options are dictated by private health insurance – approx 36% of women in Victoria give birth in private hospitals
• Bookings at private hospitals are made through specialist obstetricians – (very few general practitioners)
• Outcomes for private hospital intervention rates are consistently higher than public hospitals, even though women with complex medical needs are often referred to public hospitals
• Midwives, who by definition have a duty of care to promote normal birth, are not able to be primary care providers for any women in private obstetric care. The midwives in these hospitals are subservient to the obstetricians in all care decisions.
Maternity Service Performance Indicators are published giving detailed data for public hospitals, and only aggregate data for private hospitals.

Attachment 1.
Source: Janie Nottingham - used with permission
‘Having a baby in Victoria’
In 2006, 68 547 women utilised birthing services in Victoria, in 2007 this has grown to 72 000.

64.1% of Victorian women utilised public maternity services

200 women gave birth at home by choice

The Victorian State Government issued a paper on maternity services reform, Future Directions. This document supports the establishment of primary midwifery models of care, with particular emphasis on ‘caseload models’. Caseload midwifery is where one midwife cares for one woman. The benefits and cost savings of caseload or 1-2-1 midwifery are well documented. The World Health Organisation considers this care the most appropriate for the 75-80% of women that experience normal, healthy pregnancies.

Despite the cost savings and benefits there are few public funded ‘caseload models’

Sunshine Hospital has recently established a caseload service for 1000 women

Geelong offers a service for 470 women per year. They are turning away up to 25 women per month who want to access the service.

Royal Women’s is currently conducting a trial caseload service for 1000 women. It is well known that trials in innovative maternity care (despite positive outcomes) rarely transform into established services.

Box Hill has a Know Your Midwife service. Ironically this service does not include care in labour (the most critical time to have a known carer)

Since 1997 37 rural based obstetric units have closed, with Daylesford planned to close later this year. Only one has re-opened (Seymour). Women and their families are forced to travel for basic healthcare. The financial and emotional costs to families are considerable. There is a wealth of evidence outlining the safety and improved health outcomes of local maternity care (particularly primary midwifery care)

Rosebud Hospital closed its maternity service in 2007. Officially this was due to a loss of Obstetric cover. This decision contradicts current evidence, Victorian policy (via Future Directions) that demonstrates the safety and success of primary midwifery units.
The Angliss suspended its caseload midwifery service despite stunning outcomes in 2004. Ironically just before the release of future directions
The midwifery workforce, Australia-wide is not used to its capacity. Midwives are educated and registered to provide the entire care to healthy women.

Data sourced from the perinatal data collection unit stats

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