Anger due to cuts in private obstetricans fees

This is an interesting debate the cutting of costs for rebates in private health insurance. Previously women could claim 80 per cent of out-of-pocket obstetrics fees after reaching the safety-net threshold.
It is also interesting to see that low risk women are asked to attend local hospitals as opposed to mainstream high risk hospitals where the intervention rate is much higher. This is where we would benefit from having more birth centers, or midwives working out of hospitals within the community.
The question is will this push women to seek midwifery led care in low risk cases, as opposed to paying more to see a private obstetrician and risk the cascade of intervention..... and higher costs.
The recent newspaper article Anger over cut to obstetrics rebate discusses these issues, stating that in the current boom will we run out of beds in our hospitals.

What the article fails to mention is that midwifery led care in low risk women is a more affordable option and saves the tax payer millions of dollars.....

RANZCOG - the need to support Midwifery- Led Care - give women informed choice!

It is the 21st century and whenever we discuss midwifery, nursing and medicine it is usually in relation to evidenced based practice - the latest research - how to move forward within the professions looking at the research. I do find it ironic that when Obstetricians have good evidence to show that homebirths have a place in Maternity Care they fail to acknowledge this.

I came across this site called 6 minutes.com.au - and there was an article written by Michael Woodhead - click on the link to find the full article.

Doctors 'in denial' about safe home births The medical profession has been accused of encouraging the trend for dangerous unattended ‘freebirths’ by failing to support safe homebirths.

Obstetricians and state bureaucracies are reluctant to acknowledge that there is good evidence to support the safety of planned attended homebirths for low risk women, says a public health researcher and member of the Australian Maternity Coalition.

.... in this month’s Australia and New Zealand Journal of Obstetrics and Gynaecology (48: 450-52) she says the Royal Australian and New Zealand College of Obstetrics and Gynaecology opposes home birth, even though the balance of evidence shows that planned home births for low risk women have no greater mortality or morbidity than hospital births if attended by a qualified health professional.

This is a tragedy for women and midwives: why are obstetricians so opposed to midwifery led care? in the face of good evidence. One has to ask, what is the point of research if we do not use it?
In recent years there appears to have been an increase in popularity in freebirth, I wonder why?

The professions need to be working in collaboration with each other, respecting the knowledge, skills and ability to care for women and refer to obstetricians when we need to. Let midwives look after low risk women, that is what we do best.

Midwives are shown to have best outcomes for women.

It is really great to see a positive story about midwives in the press: I came across this story in the Sydney morning Herald. It is nothing any midwife does not already know, but it is good to see in print and raises our profile.
The story talks about midwives being the best option in terms of midwifery led care for women during pregnancy.
Kate Benson writes

Women who are cared for by midwives rather than GPs or obstetricians are less likely to lose their babies within the first six months of their pregnancies, an international review of maternity services has found. Researchers gave no reasons for the shock finding, taken from an analysis of 11 trials involving more than 12,200 women in four countries, but a spokeswoman for the Australian College of Midwives, Hannah Dahlen, said women who were seen by the same midwife during pregnancy, labour and birth usually felt more supported and less anxious, leading to reduced risk of miscarriage.

What a surprise to see that the Australian and New Zealand College of Obstetricians and Gynaecologists, are not happy with these findings. It is a shame that collaboration is not the focus.

The analysis, which is the largest undertaken in the world, also found that women in midwife-led models of care were less likely to be admitted to hospital during pregnancy, have instrumental deliveries, episiotomies or require analgesia and were more likely to have spontaneous vaginal births, feel in control during labour and better able to initiate breastfeeding.

The Australian college of Midwives spokes person Dr Dahlen said

the analysis, published by the Cochrane collaboration, considered the gold standard of assessing medical evidence, proved that midwife-led models of care had no adverse outcomes and many benefits.
"If this was a tablet, it would be mandatory that all women have it, but instead we have to deal with all this shroud waving by obstetricians. Now we know the evidence for their claims just isn't there,"

What a good analogy from Hannah Dahlen. Off course this is nothing new for midwives, we have always argued that midwifery-led care offers more for women and would reduce the Cesarean rate which is currently at 31%.
Our government needs to work towards more midwifery-led models of care and obstetricians need to start collaborating with midwives rather than always opposing us, after all we all want the same thing, informed choice for women and safe birthing options.

We need to listen to what women want, and stop being paternalistic.



Reference: Sydney Herald: http://www.smh.com.au/news/lifeandstyle/parenting/midwives-found-to-aid-babies-survival/2008/10/09/1223145589248.html