Doctors Best Placed To Provide Medical Care For Pregnant Women

Dr Pesce said Australia's perinatal rates are among the best in the world, with a further 25 per cent reduction in perinatal mortality in the last ten years.

"Any changes to the way care is currently delivered to pregnant women must ensure these high standards are maintained," Dr Pesce said.

"Because of workforce shortages, especially in remote and rural areas, it would sometimes be appropriate for obstetricians to share the care of pregnant women with midwives.

"But we believe obstetricians are best placed to make decisions about standards of care, safety of care, and which women are most appropriately looked after by which practitioners.

"A lot of obstetricians would consider accepting a greater role for midwives in the care of pregnant women, but obstetricians should choose which pregnant women are best suited to that particular care - and be on hand to provide specialised care if there are complications," Dr Pesce said.

In November 2004, the influential and respected Cochrane Review published an international review of evidence comparing perinatal deaths in midwife care birth centres and conventional hospital care.

The review found an 83 per cent higher risk of perinatal death in birth centres in a sample of 8,677 women.

"There is now good quality evidence that the emphasis on low intervention in birthing may be associated with higher perinatal death rates," Dr Pesce said.

"The study also revealed intervention rates in birth centres are only three per cent lower than for births in conventional hospital care.

"Arguments based on significant reductions in caesarean rates and instrumental vaginal deliveries are not confirmed in randomised clinical trials.

"This is borne out in comparisons of national caesarean rates. In New Zealand, where 70 per cent of women are cared for by midwives, the caesarean rate of 23 per cent in 2002 was similar to the rate in Australia, which was 25 per cent in that year," Dr Pesce said.