Obstetric Services Must Be Women-centred, Not Provider-centred, Say Obstetricians and Midwives

Authors Drs Edward Weaver and Kenneth Clark from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and Barbara Vernon from the Australian College of Midwives in Canberra, have called for an end to the 'turf wars'. saying women would not necessarily receive the best care if access to either of these professions were restricted.

The authors say an Australian National Maternity Policy should be put in place by 2020.

Maternity services in Australia in 2005 provide much choice for women, including private or public care by obstetricians, general practitioners and midwives in hospitals, birthing centres and less frequently at home.

Unlike New Zealand, Australia does not give women the option of choosing a midwife as a 'lead maternity carer' as a mainstream option in the public health system.

Maternity services reform in New Zealand have led to improvement for many women in continuity of maternity caregiver, and greater availability of non-medically based models of care for those women wanting them. The downside has been the loss of GPs as an option for maternity care and an initial exodus of experienced midwives out of the public hospital system.

With an ageing obstetric workforce there is the possibility of a major shortage of obstetricians in the next 10 years due to retirements, new RANZCOG Fellows not wishing to practise obstetrics, increased feminisation of the obstetric workforce, and problems associated with safe working hours.

"There has also been a major decrease in GPs practising obstetrics, especially in rural areas, for lifestyle reasons and because of the cost of medical indemnity," Dr Weaver said.

"The shortage of midwives is also a problem. Recruiting and retaining midwives seem to be related to midwives' perceptions of a lack of professional recognition, stress and workload issues, as well as limited opportunities for midwives to practise as primary carers and provide continuity of care to women.

To encourage discussion between maternity care providers, RANZCOG re-established the Joint Committee for Maternity Services in 2002. The Committee has representatives from RANZCOG, the Australian College of Midwives, the Royal Australian College of General Practitioners, and the Australian College of Remote and Rural Medicine, as well as consumer representation.

"There are already good examples of effective services in various places across Australia, ranging from large metropolitan units, such as the Adelaide Women's and Children's Hospital Community Midwifery Program, to rural services such as those provided at Wangaratta Hospital in Victoria, that are women-centred and based on mutual respect and collaboration between obstetricians and midwives. The challenge is to make this the norm for the benefit of mothers and babies as well as their care providers," Dr Weaver said.

The Medical Journal of Australia is a publication of the Australian Medical Association.