| Options for Maternity Care
Forum session presentation from Assoc. Prof. James King, Director of the Perinatal Epidemiology Unit, Mater Hospital, Brisbane. In 1996 the NHMRC endorsed the Report on "Options for Effective Care in Childbirth" (available through NHMRC home page). This report recommended (on the basis of a systematic review of the evidence) some far reaching changes in the way in which childbirth care is provided for Australians, which was acknowledged to be traditional (some would say this is a euphemism for anachronistic), inflexible and limited in scope. The traditional model of care for public hospital "patients" often involves the woman being seen by a bewildering array of care providers, especially in metropolitan teaching hospitals, with no identified person assuming overall responsibility. In particular, although Australia inherited from the UK a tradition of midwives being involved in maternity care, midwifery was never acknowledged here as a profession trained to assume primary care throughout the childbearing cycle. In many parts of the world, midwifery is recognised and publicly funded as the preferred option for maternity primary care (but not in Australia - or in the USA, from where many of our health care models are derived). Midwifery models of care which operate in collaboration with hospital based obstetricians and community general practitioners have been evaluated and have been shown to be as safe as and cheaper than obstetrician led care, with higher parental satisfaction rates. The other model of care available to some Australian women is primary care by a specialist obstetrician. There are some paradoxes in this because specialist obstetricians are trained to be just that, not primary care providers. The NHMRC document identified that Australia has, in comparative terms, low mortality and morbidity rates, but it has one of the highest surgical intervention rates in childbirth in the developed world, and there are no data to support a causal relationship between these two findings. The NHMRC made 15 recommendations concerning childbirth care a few of which are slowly being introduced into the options for childbirth care in Australia. Not surprisingly, there are factions opposing the introduction of expanded role of the midwife, particularly in the private sector, using the same arguments as those opposing nurse practitioners in several fields. These arguments are often developed without recourse to worldwide experience or evidence. The Doctors Reform Society should support the option of collaborative midwifery models of care being offered by public hospitals, and not support fee-for-service "private practice" options which are likely to have the same pitfalls as any other fee-for-service model.
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