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Feeling pessimistic

I’ve just finished another contribution for the Midirs Midwifery Digest - that wonderful resource that no midwife should be without. The Digest comes out four times each year and I have been sending a “Letter from OZ” for some time. I usually try to sum up the happenings in Australia for the wider world audience that forms the Midirs readership and it seems that I am always writing about the various struggles that midwives are engaged in as we try to reform midwifery services in this country.

Today’s effort was rather pessimistic, which is a bit out of character for me. The number of closures of smaller maternity units and birth centres across the country is alarming and many of us are feeling depressed and anxious at this turn of events. Lots of factors are driving this trend:

and so on......

I still believe that the economics of midwifery versus obstetrics will be the telling point, once the politicians begin to believe the evidence and stand up to the strong medical lobby groups. For too long now, the doctors have run our maternity services to suit themselves - financially, geographically, politically. Many of my midwife friends are becoming weary of the battle, which never seems to end, even though we occasionally win a skirmish or two.

Perhaps what we need are a few well publicised medical disasters, tragedies due to epidurals or unnecessary caesareans, or scares related to drugs. These kinds of headlines are the ones that grab attention and force change. The NSW State Government is under pressure to establish a Royal Commission to investigate the sad state of our health system - if this was to happen there would be a safe haven for whistleblowers to tell their stories of bungles and mismanagement. Perhaps it’s what we need to highlight the appalling mess that over- servicing by obstetricians is wreaking on women and babies.......

Posted by andrea at January 28, 2004 02:03 PM

Comments

I practise as an independent midwife in a small country town, 2 hours by road from the nearest hospital providing Obstetric services. There are 2 other midwives who also practise here. There are no Drs here who offer care to pregnant women. There are three GP Practices in town, and the 5 GPs are fully stretched providing medical care, without being on call for the unpredictable hours that birthing calls for.
We three midwives care for all the pregnant women in the town and a 50 km radius.
With the New Zealand maternity system women choose a lead maternity carer for their care through pregnancy, birth and the first 6 weeks postnatally.
One result of our isolation is a C-section rate of about 10% compared toa regional rate closer to 30%.
Because all maternity care in New Zealand is funded by the state, and all LMCs, whether midwife or GP get paid at the same rate for work of equal value, the local Drs choose not to provide a LMC service.
As practioners we back each other up if we have a tricky situation and need a second pair of hands at a birth. Or if we need to take time off.
We have access agreements to the small local hospital, and a visiting obstetrician comes twice a month if any non-urgent problems arise. If a more urgent problem arises we can arrange to have the woman seen at the major centre. Transfer can be done either in the family's own car or by ambulance if they require skilled care during the transport. In this case we escort the woman to hospital, and hand over to the hospital staff.
The LMC model of purchasing care for pregnant women is working well in NZ, and the great majority of women are reporting a very high level of satisfaction with the care they receive from their midwves.

Posted by: Kathy Young on January 31, 2004 06:48 PM

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