Reviewing Maternity Care in Australia

"Statements released by the AMA frequently discuss the rate of deaths and complications that occur during homebirths, however no similar thing exists to show the rate of death or iatrogenic complications from hospital birth."

Reviewing Maternity Care in Australia

Australian women are led to believe that our maternity care system is world class. Glossy images of contented white mothers adorn pamphlets and advertisements from one side of the country to the other, and women are herded into hospitals to give birth, either with a private surgeon, or in the public system where carers are assigned randomly.

We are told that hospital birth is safe, and that women who care about their babies do exactly what they’re told to do. But who is telling us that? Only one of the most powerful lobby groups in Australia, the Australian Medical Association, and RANZCOG, The Royal Australian and New Zealand College of Gynaecologists. That’s right, a group of people who have, at the very least a serious conflict of interest.

Interestingly, those same people who claim that our hospitals are essential for safe childbirth, refuse to provide any information about their track record. If women were able to access information about individual care providers, or hospitals, it might help them decide where they would like to give birth, and with whom. It seems odd that the very people who are so proud of the maternity care they oversee, would also deny women access to the information that supports their claims of excellence. Unfortunately the only figures available are nation wide figures, and further information is only released at the discretion of individual hospitals, or surgeons.

Some Australian hospitals have released their statistics, but there are whole states where not a single hospital will release any data about their intervention, VBAC, caesarean, induction, instrumental delivery, epidural, or other intervention rates. When a woman contacts them to inquire about – for example – their VBAC rate, they tell her to refer to the national figures, however what we know from the available public data, is that VBAC rates vary significantly between each hospital, and between the public and private systems. The national rate for VBAC in Australia is 16%. One hospital in NSW has a 28% VBAC rate (the highest in the country apparently, and one private hospital has a VBAC rate of 3%, so a standard 16% really isn’t much help to women who would like to make informed decisions.

The rate of intervention varies notably between those hospitals that have been honest enough to reveal their figures, whilst the health of Australian women is pretty similar across the country (of course the health of Indigenous women is a separate issue here because they are even more neglected by maternity services). Despite having similar health, the protocols that govern practice in maternity services throughout Australia also differ greatly. However this is something else that hospitals rarely disclose, and something that has not publicly been addressed by RANZCOG or the AMA.

Women may ask what the standard protocol is for such things as induction, or VBAC, and receive different information from each person they encounter at their chosen hospital, and there is no information available on the internet about individual hospital practices. Furthermore, when women are able to uncover a hospital’s protocols, it is not made clear that these protocols are guidelines, and that each woman can either accept or decline the interventions, or she can request other things that are not on offer – such as waterbirth or intermittent monitoring.

Australians are exceedingly privileged to receive much of their healthcare free of charge. Our universal healthcare system is undoubtedly a first rate institution, but unfortunately the maternity care Australian women receive is largely substandard. According to a statement made by Professor Sue Kruske, President of the Australian College of Midwives, only about 5% of Australian women access what the World Health Organisation refer to as “The Gold Standard of Care” or one to one caseload midwifery. Furthermore, an enormous number of women may begin their maternity care in a caseload program, only to be risked out by obstetric guidelines as they near birth.

Often women believe that because they do not pay for their maternity care, that they must do what they are instructed to do, and not inconvenience staff with any personal preferences. Conversely though, in the private system when women are paying out of pocket for their maternity care, they express the same beliefs. They believe that care providers will only do what is best for them and their baby, and are frequently left disillusioned by their experience during the actual birth. Even when women have a clear set of goals for their births, they often find themselves unable to speak up because standardised maternity care providers are efficiently pushy, disinterested in personally created birth plans, and in many cases, openly hostile.

Whether the woman pays directly or via taxes, for her healthcare, one thing remains the same. She is the only person who has the legal right to make decisions, and to do that, she needs information. Information that is currently being aggressively withheld. The perception of Australian society is that the AMA and RANZCOG have the best interests of women and babies at heart when they make their guidelines, however that is hard to support when they suppress vital information, and use emotive, guilt laden, public statements to discredit out of hospital midwifery – a standard of care which actually does release data for public comment.

Statements released by the AMA frequently discuss the rate of deaths and complications that occur during homebirths, however no similar thing exists to show the rate of death or iatrogenic complications from hospital birth. This is made even murkier when we see how each and every death that occurs outside of a hospital results in an inquest, however it is exceedingly rare for  an inquest to be held into a death that occurred in a hospital, even when the family in question would like one. Moreover, a midwife can be struck off after one poor outcome (or as in many cases, one report where no poor outcome eventuated) however multiple reports about doctors such as Graeme Reeves, are swept under the rug. This is not to suggest that all midwives are perfect, the point is that doctors should be held accountable to the same standards.

The fact remains that AMA and RANZCOG are lobby groups. Their job is to protect the financial stakes and working conditions of their members, not to defend the rights of women and babies. To believe otherwise is folly. It’s like believing that the The Australian Hotels Association has the best interests of gamblers at heart as they fight against laws that would ban pokie machines. The overzealous defense of the high intervention and caesarean rates by the AMA and RANZCOG, their refusal to cooperate with independent midwives in collaborative arrangements, and their complete dismissal and vocal criticism of such protocols as the independently created “Towards Normal Birth” initiative which was specifically designed to lower the high rates of intervention and caesarean birth, highlight just how disinterested they are in improving services and safety for women.

Unfortunately, having lots of machinery and protocols, has not made birth safer for all women, despite claims to the contrary. The glossy pamphlets and grand public statements of RANZCOG and AMA members lead women to believe otherwise. No matter how much money is spent on creating glossy pamphlets, buying new technology, or increasing interventions and testing in pregnancy, the outcomes keep showing that what we need in the majority of births is LESS. Less standardised care. We need more individualised care, and more information about how maternity carers are performing compared to their colleagues, because if women were able to vote with their money (or money paid on their behalf) we might see the birthing culture in Australia changing rapidly for the better.

Segment of the Australian flag
Australia needs honesty in maternity care
License: Creative Commons CC0.

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