Tuesday, February 17, 2009

Public and private maternity hospital outcomes

A new research paper, 'Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study' (authors: Stephen J Robson, Paula Laws and Elizabeth A Sullivan) has been published in the Medical Journal of Australia, and is available online.

It’s interesting that the publication of this paper coincides with the release of the report of the National Health and Hospitals Reform Commission, the federal government’s main advisory body on health reform – a report which seeks to send 14% of wages to private health funds!!!. See the article in today's Age.

I think the paper itself fails to identify the most important issue in private maternity care - that in private care the woman has a known primary or leading carer who is committed to overseeing all professional decisions, whereas in most public care the woman has no such trusted primary carer. We know that women have higher levels of satisfaction with private care when compared with fragmented public options. It’s a no-brainer!

Some years ago I spoke on Jon Faine’s ABC radio program, and Christine Tippett was also there. Dr Tippett said that she loves to do midwifery, indicating that she gets quite a buzz out of an uncomplicated spontaneous birth. I think this is a widely held view in obstetrics, and although I was firstly puzzled then outraged, I have realised that it’s probably true. Doctors who are providing primary care for well women who require no ‘help’ to get their babies out are doing the work of the midwife, in having a sort of partnership with the woman, who trusts them. The person in the room who actually has the qualification of ‘midwife’ is functioning as an assistant to the primary carer who actually happens to be a specialist obstetrician. And please note that that midwife could not provide a similar service as the doctor, because the woman trusts the doctor, not the midwife.

There is no sense at all in supporting ‘public’ over ‘private’ maternity services as they are currently offered in the Australian context. All women giving birth need to be able to trust the person who is making professional decisions, and 'public' women ought to be able to access that option too. We know that the midwife is able to provide this service, and collaborate with specialist doctors and services when complications arise. This is the point that midwifery and consumer advocates need to make loudly and clearly.

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