Next Steps: National Strategic Approach to Maternity Services (NSAMS)

As I've discussed previously here and here on this blog, there is a National Strategic Approach to Maternity Services (NSAMS) in the process of being written for Australia.  Despite the overwhelming and extraordinary amount of evidence of the benefits of Continuity of Midwifery Care, the draft NSAMS omits it. The graphic below from the World Health Organisation (WHO) shows exactly what benefits there are for women and their babies when they have their own midwife. 

The omission of this simple, exquisitely effective and profoundly important 'intervention' for childbearing women and their families in the draft National Strategic Approach to Maternity Services (NSAMS) is appalling and must be corrected.  Continiuty of Midwifery Care must be the essential part of any Maternity Service and certainly the National Strategy for Maternity Services. 

The Council of Australian Governments (COAG) is meeting this week and will be discussing the draft NSAMS

Please write urgently to your State and Federal Member of Parliament and alert them to the issue and request they ensure that Continuity of Midwifery Care is the default for Maternity services and must be avaiable across the board for childbearing women throughout Australia - it is the safe, sensible and satisfying option for maternity care with short and long term health and budget implications. 

You can find your local Federal Members of Parliament here

To find your State/Territory MP, google your state/territory government and a link will come up for you. 

My letter is below - you are welcome to copy/use it for your email to your local members; if you want a copy of the letter sent to the Hon Mr Greg Hunt, please email me on thinkbirth@gmail.com

Dear ... 

I am writing to you as my State Member of Parliament to ask you to ensure that Continuity of Midwifery Care (CoMC) is promoted in the National Strategic Approach to Maternity Services (NSAMS) and written into policy that it should be available across the board to all childbearing women throughout Australia.  Could you please inform your State MP colleagues in the Labor Party of the importance of this inclusion and also promote the need to include CoMC in NSAMS with the Hon Brad Hazzard as NSW Minister for Health and the Hon Bronwyn Taylor as NSW Minister for Women. 

So you are fully informed about this issue, please find attached a letter written to Hon Mr Greg Hunt about the omission of midwifery continuity of care in the draft National Strategic Approach to Maternity Services. Our message for the Minister was not to sign off on NSAMS without continuity of midwifery care being identified as the model supported by the evidence and that is should be universally accessible.

The letter contains the evidence clearly articulated as to why, for the wellbeing of women and their infants, continuity of midwifery care should be the basis of the maternity health care system. I've also attached a very recent article which found a significant reduction in morbidity for women and their infants with midwifery continuity of care, compared with care in an obstetric-led tertiary level maternity hospital. 

These reductions in morbidity and mortality through continuity of midwifery care for women and their infants have short and long term implications for not only the health and wellbeing of these people but also for the health care dollar.  Expenditure on maternity care would be significantly reduced with a national continuity of midwifery care approach to maternity service provision.

Sincerely, 

Carolyn 

We can do this Australia, let the Government know your thoughts!

Blind spot in the Australian Government's National Action Plan for the Health of Children and Young People

The Australian Government has, sensibly, recognised the health of children and young people as important to the health and wellbeing of Australian society in general.

A National Action Plan for the Health of Children and Young People is being developed to take a life course approach in providing a road map for a national approach to providing this cohort to the best start in life.

The Draft National Plan can be accessed here 

On page 8 of the draft plan, the key life stages for children and young people are noted as below:

As you would expect, 'preconception to birth and early childhood' are recognised as the foundation of the life cycle and one of the key life stages for children and young people.

The plan says they are taking a ‘life course’ approach and acknowledge preconception, antenatal and infancy time as the beginning of that and a ‘key life stage’ and say they are focusing on prevention and early intervention. There are thirteen priority actions for implementation

However, the plan has a gigantic blind spot in regard to the best way to focus on and succeed with ‘prevention and early intervention’, despite an avalanche of evidence about what works in this area of health care.  

Ensuring the health needs of First Nation Peoples, Rural and Remote Families and Vulnerable Families are met is entirely appropriate.  It makes sense that the plan would seek to ‘Expand support for families, especially families living with adversity’, however, the plan lists the following priority actions:

Priority Four is to 'Roll-out sustained nurse home visiting programs commencing antenatally and with a focus on women living in adversity'. 
Priority Five is to 'Expand evidence-based sustained nurse home visiting programs for Australian Indigenous families' - a US based program where midwifery is unknown in the main.

Where is the role of the midwife? 

Despite the overwhelming amount of evidence demonstrating that continuity of midwifery care improves an array of important outcomes for women and their infants, the midwife is missing from this document. 

You can read the plan here:  https://consultations.health.gov.au/population-health-and-sport-division-1/establishing-a-national-action-plan-for-the-health/

Please add your voice to the survey seeking feedback on the plan.

The invitation to comment on the plan opened on the 18 March 2019 and closes 28 March 2019

Information on the plan and the link to the survey can be found here

Children and Youth of Australia need your help to ensure continuity of midwifery care is embedded in the plan. 

The following important points to include in your response are:

• Getting it right from the start – the plethora of evidence supporting continuity of midwifery care to do just that
• The research based reasons to ensure women have access to continuity of midwifery care
• Implement Caseload models of midwifery care in rural and remote areas, as well as urban communities as that model is best practice Primary Health Care and Community Development
• Extending midwifery scope of practice from preconception to early years with appropriate educational opportunities for midwives
• The need for the involvement of the Australian College of Midwives (ACM) why they were not part of the consultation team is impossible to understand
• Midwives work to build capacity and wellbeing in childbearing women and families
• Why are we fragmenting care by introducing a home nursing service  
• Why are we following an American model of care where midwives are relatively unknown and when maternal and infant morbidity and mortality is increasing in the USA
• We have well educated and competent midwives in Australia - a professional group well placed to provide life saving and life enhancing care for childbearing women and their infants

Your voice is important. Let's make a real difference to the children and youth of Australia.

Let's ensure all childbearing women have access to continuity of midwifery care and the future reaps the benefits. 




More references, courtesy of a reader - thank you!

1. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016; 4: Cd004667.
2. Tracy SK, Hartz DL, Tracy MB, et al. Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. The Lancet 2013; 382(9906): 1723-32.
3. McLachlan HL, Forster DA, Davey MA, et al. Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology 2012; 119(12): 1483-92.
4. Kildea S, Simcock G, Liu A, et al. Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study. Archives of Women's Mental Health 2018; 21(2): 203-14.
5. Kildea S, Hickey S, Nelson C, et al. Birthing on Country (in Our Community): a case study of engaging stakeholders and developing a best-practice Indigenous maternity service in an urban setting. Aust Health Rev 2018; 42(2): 230-8.
6. Gao Y, Gold L, Josif C, et al. A cost-consequences analysis of a Midwifery Group Practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia. Midwifery 2014; 30(4): 447-55.
7. Toohill J, Turkstra E, Gamble J, Scuffham PA. A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital. Midwifery 2012; 28(6): e874-e9.
8. Department of Health and Aging. Improving maternity services in Australia: A discussion paper from the Australian Government: Commonwealth of Australia, 2009.
9. AHMAC. National Maternity Services Plan, 2011. Canberra: Australian Health Ministers Advisory Council, Commonwealth of Australia, 2011.
 

 

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.