An update on the National Strategic Approach to Maternity Services

As I wrote on this blog in June last year, there has been a consultation process to develop a National Strategic Approach to Maternity Services in Australia.  You can read that post here.

I attended one of the community consultations held in Brisbane and was disturbed by the way the event was orchestrated - the agenda was preset and restricted. Any voice which sought to talk about continuity of midwifery care was shut down.  I wrote to my local member, Justine Elliot MP about my concerns.

Dear Justine Elliot MP,

Please support our call for all women to have access to continuity of Midwifery care. We are fortunate in the Tweed to have three Midwifery Group Practices, but too many women are missing out on that excellent and safer care. Only one group offers birth at home.

Women want access to a known midwife for their antenatal, postnatal and birth care. The current developing national maternity plan (National Strategic Approach to Maternity Services, NSAMS "Towards Woman-Centred Care") has omitted midwifery-led continuity of care as a preferred model of care. 
This omission is disgraceful.
Despite high quality evidence, exemplary models around the world and mothers demanding access to continuity of midwifery carer (a known midwife) via:
- every state and national review of maternity services
- 540 recent survey responses from public consultation of the new national maternity plan
- representation on the Expert Advisory Group for the national maternity plan
- public face to face consultations around the country Our voices have continued to be ignored.

Only 8% of women can access this model, yet demand across the country far exceeds this. Our new national plan is an opportunity for women to access their preferred model of care, which results in better outcomes and is far more cost effective (approx. savings of $500/birth).

I want continuity of midwifery care to be accessible for every Australian woman who wants access to it. The national maternity plan (NSAMS) is an opportunity to lead the way to truly be working "Towards Woman-Centred Care", if it incorporated the masses of feedback from mums across Australia.

Please lobby for the women across Australia and in our own area who are unable to access this care.

Yours sincerely,
Carolyn Hastie
Murwillumbah, New South Wales, 2484, Australia

 
I received a letter this afternoon from the health minister, Greg Hunt MP. 

Good afternoon

Thank you for taking the time to email me on this important issue.

I can assure you that your views are being heard and I can guarantee that the role of midwives will be recognised and included in maternity care.

It was at the request of midwives and consumers, that I intervened, after concerns were raised when the process was being led by Queensland.  We have instead taken the lead to develop a National Strategic Approach to Maternity Services (NSAMS) on behalf of the Australian Health Ministers Advisory Council.

The aim of this process is to provide choice of access which includes all models of care, including midwives.

During October – November 2018 consultations were undertaken on the draft NSAMS. 480 health professionals, service providers and consumers attended workshops, conference presentations and webinars. Over 200 individuals and 25 organisations made online submissions and completed an online survey. A report of the online survey and copies of the submissions are available on the Department of Health website.

The resulting DRAFT document Towards woman-centred care - Strategic directions for Australian maternity services is structured around the four values of respect, access, choice and safety which underpin twelve principles for woman-centred maternity care that apply to all health professionals providing maternity services. They are aligned with the Respectful Maternity Care Charter: The Universal Rights of Childbearing Women. Together, the values and principles offer an enduring framework for high quality maternity care in Australia.

Feedback in the consultations has been supportive of continuity of care meaning that there should be a shared understanding of care pathways by all health professionals involved in a woman’s care, with the aim of reducing fragmented care and conflicting advice.

The NSAMS must also be considered by all the State and Territory Health Ministers before it is finalised.

You may also be aware that there is a separate process underway examining the Medicare Benefits Schedule relating to maternity care.  The draft report has now been released. http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSR-pcrg-consult.

Both of these reports are draft and I will consider them carefully and how they interact.

I care deeply for the health of pregnant women and their babies and recognise the important role of midwifery continuity of care.

Best wishes,

The Hon Greg Hunt MP
Minister for Health Minister.Hunt@health.gov.au

I just replied to Minister Hunt's email tonight as below::

Dear Minister Hunt,

Thank you for your email.

I'm disappointed to note that your response has not taken into account what women are asking for and what is meant by continuity of Midwifery care. Continuity of care relates to the current model of GP/Hospital shared care models and private obstetric care.  The evidence shows that outcomes between continuity of care and continuity of midwifery care are chalk and cheese - very different.  Continuity of Midwifery Care and Continuity of Care are not terms which can be used as meaning the same thing, because they don't.  This confusion of terms and what they mean is unfortunately widespread in some circles.

The following figures demonstrate the differences in outcomes between the two models.  With Continuity of MIdwifery Care, there is a 24% reduction in preterm birth; 16% less neonatal loss and all fetal loss before and after 24 weeks; less surgical birth (caesarean), greater satisfaction for women, increased long term breastfeeding rates and reduced cost to the taxpayer.  There are other benefits, including lower rates of postnatal depression and improved mother/father-infant bonding, along with long term health of the newborn individual. Obstetric care, however, has seen a steady rise in surgical birth for the last few decades and is currently around 40% plus and much higher in some private hospitals.  Surgical births, whilst required for approximately 16 - 20% of the childbearing population, and expensive, but safe for the first surgical birth, comes with risks, those risks increasing with each subsequent surgical birth.

Please see the link to an overview of  The Lancet Maternal Health Series: Drives of Maternity Care in High Income Countries https://www.mhtf.org/2016/11/14/the-lancet-maternal-health-series-drivers-of-maternity-care-in-high-income-countries/on the Maternal Health Task Force at the Harvard T.H. Chan School of Public Health which provides information that will be of use in understanding the evidence regarding the benefits of Continuity of Midwifery Care.

The original article is available here https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31527-6/fulltext

The effort to develop a National Strategic Approach to Maternity Services (NSAMS) is crucial.  However, the draft, Towards woman-centred care - Strategic directions for Australian maternity services misses the point. Women don't want a document that is aiming 'towards' what they want in practice.  Women want and deserve a National Strategy that has Continuity of Midwifery Care as the central strategy and with universal access for all women, including rural and remote women. Continuity of Midwifery Care in Aboriginal communities would help Close the Gap in Maternal and Infant Health outcomes.

You mentioned the consultation process for the Strategy. I attended the meeting in Brisbane and it was a sham.  The facilitator was controlling and ensured that the conversation was limited to a preset and limited agenda.  I do not believe the consultation process can be trusted to provide a true reflection of the wider community's response and interest in the way maternity services are formulated.

I would appreciate an opportunity to meet with you to discuss the evidence for Continuity of Midwifery Care and the ways a well researched and formulated National Approach to Maternity Services can ensure that the health of the Australian Community is improved, one woman, one family, one birth, one baby at a time. The health care dollar will be better utilised by implementing universal continuity of midwifery care and the cost to the taxpayer will be greatly reduced.

Sincerely,

Carolyn

Carolyn Hastie

Midwife, PhD student

Phone: 0418428430 

Strength is not about overwhelming or overpowering - it is the subtle power of inner perseverance and kindness for others when faced with trials and hardships - Audrey Hepburn

I acknowledge the traditional custodians of the land on which I work and live and pay my respect to the Elders past and present. I acknowledge the loss of lands, cultures and treasures that have had immense consequences for people, communities and nations

 Please let Minister Hunt know your thoughts.  You can email Minister Greg Hunt here Minister.Hunt@health.gov.au