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.

 Photo: Vera Tate, Carmel Cockburn and Virginia Meyjes inside Ingham Health service's birthing room, with Curtis who was one of the first babies to be born at the re-opened service. (ABC North Queensland: Nathalie Fernbach)

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.