Sunday, 3 March 2019

Birthing in the Bush: AMA telling porkies

Queensland, like much of Australia, has seen closures of small rural maternity units. These closures are forcing labouring women to travel huge distances from their homes to a major centre to give birth.  Women who travel to distant hospitals have to pay for expensive accommodation in the town if they want to travel and wait for labour to occur, rather than risk the road in labour. Naturally, birth being what it is, women are far too often giving birth on the side of the road, rather than having their babies safely with the expert help of midwives they've come to know and trust.

One town fought long and hard to keep their birthing service to no avail. Another town, after 10 years of campaigning had their birthing service reopened with a continuity of midwifery care model.
In the 12 months since its re-opening, the service has assisted 100 all-risk women with antenatal and postnatal care, and 47 low-risk women have given birth there.
Ingham birthing service staff sit alongside a mum holding her one-year-old son inside the birthing room.

The government is looking at options for reopening other maternity units and considering increasing the number of birthing services with continuity of midwifery care for local women.

Despite the plethora of evidence that continuity of midwifery care is safe, cost-effective, that it closes the gap for Aboriginal women on the rate of premature births and that it has been estimated that if it were implemented world wide the rate of maternal death, neonatal death, stillbirth, premature birth and women's dissatisfaction with care would plummet, the Australian Medical Association (AMA) continues to try to put roadblocks in the way of reforming maternity services to meet women's needs in an evidence-based way.

A recent newspaper article about the bush maternity service crisis, quoted the Queensland branch of the AMA (AMAQ)’s submission which correctly reported “there is evidence that closing maternity and birthing services can actually result in poorer health outcomes”. Instead of supporting the childbearing population with their desire to see an expansion of continiuty of midwifery care, the AMA spokesperson claimed the following untruths:

“There is ample evidence that perceived low-risk pregnancies often turn out to be high risk,” the submission said. “In these situations, the first time a doctor sees the patient should not be when labour is obstructed or a severe complication develops or becomes apparent.
“We strongly caution against the further introduction of midwife-led-only caseload models without medical backup. We have feedback from members which indicates this experiment has been trialled and failed in parts of rural and regional Queensland, particularly given the evidence which indicates a doubling of perinatal mortality under this model.”
These words are nonsense and contribute nothing to further best-practice maternity services for childbearing women in rural and remote areas.  The AMA should be ashamed of themselves - they are telling porkies.  Whilst there are many fantastic doctors - obstetricians and GP's who care about women's health and wellbeing and respectfully pay attention to what women say they want, the behaviour of the AMA makes it clear that as an organisation, they are invested in power over and control of maternity services, rather than collaborative care with the needs and wants of childbearing women at the centre of their practice.  According to Richard Smith, previously an editor of the British Medical Journal, a gastroenterologist from Cork 'has written an incisive critique of modern medicine', suggesting that medicine has 'lost its way', stating:
the medicalisation of life and death; runaway costs; ever declining value; patients reduced to consumers; growing empires of doctors, other health workers, and researchers; and the industrialisation of healthcare are now a reality
If this is true, and various articles about bullying and suicide rates in medicine, amongst other issues suggests that what the gastroenterologist has written is true, then it is time for the AMA to take a good hard look at itself, to undertake a reflexive approach to its organisation and practice - time to shine a light on its behaviour and beliefs.

Childbearing women of Australia, their partners and their infants deserve that respect. 


Unknown said...

Excellent critique Carolyn - I know this is another statement that contributes to the "Tipping Point " for positive evidence based change.

Carolyn Hastie said...

Thank you for commenting, that's very kind. I agree, we are on the cusp of change. The institutions of the patriarchy are crumbling. They need to shape up and change or their days are numbered.

Georgina Bosworth said...

Fabulous rebuttal... So proud of our birthing community nation wide, women, midwives, midwifery academics and leaders. Our solidarity and the overwhelming evidence can’t be ignored. Proud to be part of this team. Ingham MGP. When they go low - we go high.

Sarah said...

Thank-you Ms Hastie, this needs to be said and I commend your courage in speaking out. The AMA should not be allowed to present themselves as a "Medical association" because it is unclear to politicians, public servants and indeed the public that what they truly are is a union for doctors. People outside of maternity services and allied health think the AMA speak for health and base their submissions and releases on high level evidence and this is simply not the case.

The politics of power are made quite evident when we seek to subvert them. I am fond of asking what the response would be if the ACM or ANMF spoke as the AMA does about other professions/disciplines. We know that even when the ACM base their submissions on evidence they are given a hard time by the media and AMA for daring to suggest the AMA may be fallible.

Anonymous said...

Eloquently & accurately expressed Carolyn. Thank you!

Kay Hardie said...

Carolyn, thank you for this excellent blog. Astounding really..... when evidence from research is 'dissed' to manipulate and control 50% of the Australian population!! Shame on you AMA

Carolyn Hastie said...

It is astounding Kay. The AMA has a lot of soul searching to do! Meanwhile, we will hold them to account. Not that it ever was acceptable to lie to the public, but they are less and less able to get away with it now. People are wising up.

Carolyn Hastie said...

Thank you for all you do Georgina - you are doing so much to make life better for the women and families in your area. Thank you too for your comments on this blog post. I appreciate your thoughts.

Carolyn Hastie said...

Thank you Sarah - you are so right when you say 'The politics of power are made quite evident when we seek to subvert them'. They are also quite evident when women seek sovereignty over their bodies. This willingness on the part of the AMA to control women and use power, threat and fear to control what women do with their bodies has had its day.