SUBMISSION

ENQUIRY INTO PERINATAL SERVICES PARLIAMENT OF VICTORIA - FAMILY AND COMMUNITY DEVELOPMENT

Terms of Reference

Received from the Legislative Council on 16 September 2015:

That this house, pursuant to section 33 of the Parliamentary Committees Act 2003, requires the Family and Community

Development Committee to inquire into, consider and report no later than 30 June 2016* on the current situation relating

to the health, care and wellbeing of mothers and babies in Victoria during the perinatal period, including —

1. the availability, quality and safety of health services delivering services to women and their babies during

the perinatal period;

2. the impact that the loss of commonwealth funding (in particular, the National Perinatal Depression

Initiative) will have on Victorian hospitals and medical facilities as well as on the health and wellbeing of

Victorian families;

3. the adequacy of the number, location, distribution, quality and safety of health services capable of dealing

with high-risk and premature births in Victoria;

4. the quality, safety and effectiveness of current methods to reduce the incidence of maternal and infant

mortality and premature births;

5. access to and provision of an appropriately qualified workforce, including midwives, paediatricians,

obstetricians, general practitioners, anaesthetists, maternal and child health nurses, mental health

practitioners and lactation consultants across Victoria;

6. disparity in outcomes between rural and regional and metropolitan locations; and

7. identification of best practice.

FULL NAME: Laura M Stubbings

ARE YOU SEEKING CONFIDENTIALITY? YES / NO

2

All submissions are public documents (and may be published on the Committee’s website) unless confidentiality is requested and granted by the Committee. Please note that submissions will be published on this page as they are processed by the Committee. Your name will be published with your submission, but your contact details will be removed.

PERSONAL SUBMISSION

In planning my birth, there appeared to be only two options available to me: to relinquish all power and be

part of a conveyor belt of births under time pressure in a hospital or to plan a homebirth: super-clinical or

super-alternative with no middle ground. True continuity of care was what I had wanted, but I didn’t

know how to ask for that, so I planned a homebirth because it seemed the only way to be sure I would

have my views and approach to birth respected. So much of the discussion in preparation for birth was

about how to avoid being pushed or rushed into choices within a clinical setting, specifically unnecessary

or sooner-than-needed intervention.

My waters broke early, necessitating monitoring and antibiotics during labour; my baby was born at the

Northern Hospital, Epping in the birth suite with a private midwife. This was a great outcome and as close

the homebirth experience as I was likely to have- and in fact it was the experience I had looked for, but

didn’t think existed.

Hour-long pre- and post-natal appointments gave me the space to discuss all ideas and concerns and to

feel listened to and capable to approach each stage. Post-natal support from the same midwife gave me a

sense of confidence, help establishing breastfeeding and ongoing support.

I would like to see better awareness- in the general population and in people in early pregnancy in

particular- of the options available for birth. Private midwives working together with hospitals provide an

excellent combination of personal care and availability of clinical support if a natural physiological birth

does not go to plan.

GROUP SUBMISSION - “MY MIDWIVES MELBOURNE PARENTS GROUP”

3

We are a collective of parents who have engaged the services of ‘My Midwives

Melbourne’ for pregnancy, birth and postnatal midwifery care. Collectively, we all

have varied backgrounds, lifestyles and values but have all come together with this

Parents Group because we have chosen a Continuity-of-Care Midwifery model for

the birth of our children. Our group has come together to share our experiences as

Consumers of Maternity Care in Victoria.

SUMMARY OF POINTS EXPRESSED IN MEETING 11.7.17

● Options for pregnancy care are not well known by the general public

● Women have found out about Continuity-of-Care via accident, word of mouth or from friends but

the option is not well known

● Some women thought that the only option for Continuity-of-Care was to have a home birth, and

didn’t realise they could have their chosen midwife in hospital

● More public information about care options is needed

● Non-biased information regarding options for care should be given to GP’s (such public, private

midwife, private obstetrician, including statistics) and preferably with information in written

format such as handouts for patients and partners

● Department of Health should have clear and concise information on their website about the

options for care in Victoria (such public hospital, public home birth program, private hospital,

private midwife in public hospital, private midwife home birth, private obstetrician, including

statistics). Then women may have more knowledge about what options to seek out in their local

area.

● “High Risk” pregnancies have more limited and sometimes no option for Continuity-of-Care with

midwife (E.g. High BMI, pre-existing diabetes).

● The role of a Midwife and the role of an Obstetrician in pregnancy and birth care needs to be

more clearly defined to the public

● There is confusion about the role of an Obstetrician in pregnancy and birth - they are specialists

in High Risk or complicated births, not usually present for Low Risk or uncomplicated births.

● New Zealand model of care is more comprehensive, ensuring that all women have access to

Continuity-of-Care (Lead-Maternity-Carer) https://www.midwife.org.nz/in-new-

zealand/contexts-for-practice

4

● Other countries that have Continuity-of-Care models across the entire health service have better

outcomes for mothers and babies. I.e. The Netherlands, Sweden.

● Rural women have much greater restriction to Continuity-of-Care models

● Rural women travel for much greater distances to access Continuity-of-Care

● Without Continuity-of-Care women often do not get enough consistent support and education in

the antenatal and postnatal period, which can lead to feeling anxious, disempowered. E.g.-

breastfeeding, caring for newborn

● No one size fits all - each person needs to be treated as an individual and not all hospital policies

will suit everyone. Need personalised care to feel empowered, respected and safe. Patient-centre

care rather than Hospital-centred care.

● Through most models of care women experience long waiting times for appointments and then

are rushed through quick appointments where they don’t get time to ask questions. As a result can

feel upset, disappointed, rushed, not listened to.

● Hospital birth classes - are often teaching resistance against “hospital system” rather than

empowerment or working as a team with care providers, this encourages fear and anxiety about

birth.

● Cochrane Review of Maternity Services concluded that “Most women should be offered

‘midwife-led continuity of care’. It provides benefits for women and babies and we have

identified no adverse effects” .http://www.cochrane.org/CD004667/PREG_midwife-led-

continuity-models-care-compared-other-models-care-women-during-pregnancy-birth-and-

early

● Continuity of Care with a known midwife has better outcomes for mothers and babies

overall

● We therefore have a moral obligation to ensure that women know about and are offered

Continuity-of-Care with a midwife

● There needs to be more Continuity-of-Care services throughout Victoria.

● Private midwife visiting-access model of care should be accessible in all hospitals so that women

can choose this model throughout Victoria without adding additional costs to the Health Service.

● Pregnancy care and birthing with a Private Midwife in a public hospital reduces the financial

strain for the hospital and relieves the physical work pressures/stress for hospital staff, ie. patient

has most of pregnancy and postnatal care outside of the hospital and brings own midwife for birth

in hospital.

● Some women have decided not to move to rural areas because they will not be able to access

midwifery Continuity-of-Care

5

● Some women are going to relocate their whole family prior to birth in order to have midwifery

Continuity-of-Care

● Some women are driving much further past their closest hospital to have their own private

midwife assist with their birth in a hospital which will allow it. For this reason it would be good if

all Maternity health services give women this option.

● We need proactive change from a system point of view - rather than having a private midwife

seen as a lifestyle choice, it should be promoted as a “normal” or natural choice

● Changing public perception of birth from traumatic event to positive life event. Strong desire to

pass on positive birth stories from generation to generation.

● Public perception that women who choose to have private midwife are “Earth Mother” types

rather than all walks of life, stay-at-home-mums, professionals, artists, health-care workers, etc.

● Home birth lobby movement is perceived as radical and irresponsible in Australia, even though

statistically homebirth is safe option for low risk women. Therefore we would like to see

publicly-funded homebirth programs in Victoria.

● We need to change the language around midwifery care/homebirth to talk less about emotive

issues and more about statistics and evidence based practice.

● Being clear about the role of care providers is important, take emotions out of the conversation

and stick to facts.

● Women’s experiences of Continuity-of-Care is more family oriented. I.e - all the family are

involved, whole family supported rather than just the woman, siblings involved in care.

● Continuity of care was considered fundamental to achieving quality outcomes when models

of care evaluated in QLD (Where there are many more services that offer private midwifery

care for birth) http://www.womenandbirth.org/article/S1871-5192(17)30062-8/fulltext