Maternity care

Urgent action needed following Birth Trauma report

August 30, 2024 by Rayan Calimlim Leave a Comment

The NSW Government has failed to recognise the urgency of the midwifery workforce crisis, after releasing its response to the recommendations of the state’s first Birth Trauma Inquiry.

The NSW Nurses and Midwives Association (NSWNMA) welcomed the state government’s support of 42 of the 43 recommendations but was disappointed by the lack of immediate and proactive measures to improve workforce challenges and maternity care.

NSWNMA Assistant General Secretary, and midwife, Michael Whaites, said the state government needed to focus on fixing the midwifery staffing crisis.

“Midwives strive to deliver the best possible care to women and babies in a system that has been chronically understaffed, under-resourced and neglected for far too long. This cannot continue any longer,” said Mr Whaites.

“The government must recognise poor pay and conditions are driving the severe staffing shortages and as a result, there’s an inability for midwives to intervene.

“The government is refusing to acknowledge the pivotal role of midwives and the centrality of midwives to the solutions. There needs to be significant investment into the midwifery workforce, because if the government doesn’t act to address these staffing shortages, the ambition of the Maternity Care Blueprint will not be recognised.

“We need to see competitive rates of pay and a staffing model with the appropriate skill-mix. We continue to advocate for safe staffing ratios in maternity with one midwife to every three women in postnatal wards.

“It’s pleasing to see the government recognises the importance of midwifery-led continuity of care models and is committed to increasing access to these care models, as well as improving support for women with postnatal debriefings.

“It’s evident that the government cannot sit on its hands any longer. It must urgently act to stem the loss of midwives, if it is serious about improving maternity care for women and babies in this state.”

First Nations women are at greater risk of stillbirth. Here’s why – and what we can do about it

August 28, 2024 by Rayan Calimlim Leave a Comment

Australian national data show First Nations women face almost twice the risk of stillbirth or “sorry business babies” compared to non-First Nations women.

To address this inequity, Australia’s national stillbirth action plan focuses on ensuring culturally safe stillbirth prevention and care for First Nations women.

But first, we must understand the underlying reasons for the ongoing disparities in stillbirth rates and other pregnancy-related outcomes.

We argue much of the inequity can be linked to the ongoing impact of colonisation on First Nations women and birthing. Here’s why.

Ongoing intergenerational trauma

First Nations people have lived in Australia for at least 65,000 years. Prior to European invasion and settlement in 1788, more than 2,000 generations of First Nations people lived in connection to family, community, Country and their ancestors.

Colonisation saw First Nations women stripped of their traditional pregnancy and birthing practices, including use of medicinal plants, techniques for active labour and pain control, and songs for labour.

From the mid-1800s to the 1970s, First Nations babies and children were forcibly removed from their communities and placed with non-First Nations families.

Loss of land, violence and abuse, medical experimentation, cultural suppression and other systemic injustices have led to widespread intergenerational trauma that contributes to poorer health outcomes today.

Intergenerational trauma described in four minutes (The Healing Foundation)

Maternity services aren’t designed for First Nations women

Historical violence and exclusion have led to an intergenerational distrust of colonial systems, services and spaces among First Nations people. First Nations people have been expected to adapt to a Western health service, rather than these services adapting to First Nations people’s ways of knowing, being and doing.

There is also a shortage of First Nations health-care workers. This further limits First Nations people’s access to culturally responsive care.

Recognition of the importance of Birthing on Country has led to services like Waminda and Birthing In Our Community.

But there aren’t enough of these services for all First Nations women. And barriers to setting up the services persist.

Resources aren’t designed for First Nations women

Pregnancy information resources have historically been designed for a colonial audience. These resources do not speak to First Nations women and have rarely been developed by and with First Nations people.

More contemporary initiatives have better engaged First Nations people in, or have them lead, resource development.

The Centre of Research Excellence in Stillbirth’s Indigenous Advisory Group recently led the development of the Stronger Bubba Born pregnancy information website and resources for First Nations women. The information is the same as that given to non-First Nations women, as part of the Safer Baby Bundle, but it has been culturally adapted for its target audience.

Stronger Bubba Born introductory video (The Stillbirth Centre of Research Excellence)

Racism and discrimination in maternity services

While some First Nations women face overt racism in maternity services, many more are discriminated against through implicit biases. This is where care providers’ unconsciously held beliefs about First Nations people influence their judgements of and interactions with pregnant First Nations women.

Active stereotypes that are commonly applied to pregnant First Nations women include assuming drug and alcohol use and a perceived unsuitability for motherhood. This stems from the historical marginalisation of First Nations people.

But implicit bias isn’t the only source. Institutional racism also contributes to worse health outcomes among First Nations women. It occurs because of embedded structures or policies that perpetuate racial disparities, and it often goes unnoticed by non-First Nations midwives. Institutional racism plays out in various ways, including restrictions on the numbers of family/support people able to visit.

All of this leads to power imbalances and First Nations women being less likely to attend antenatal appointments.

Providers don’t understand First Nations health

The Australian First Nations view of health differs from the Western view. Connection to family, Country and community defines First Nations people’s health, rather than illness, disease, and notions of “risk”.

Physical, spiritual, cultural, social, emotional and mental health are interconnected, and land is a source of strength, identity and healing.

These concepts form the foundation of Birthing on Country and underscore the importance of self-determination in providing culturally responsive maternity care.

Yet maternity care providers have limited knowledge of First Nations women’s cultural needs and little education and training on this.

Where to from here?

To eliminate racial disparities in stillbirth rates in Australia, our health system and broader society needs to recognise the effects of colonisation and the structural forces that continue to influence First Nations people’s health.

This requires acknowledging and sitting in discomfort with Australia’s history.

The Healthy Yarning Guide is a workshop based on two-way learning and yarning for non-First Nations maternity care providers and maternity service administrations.

The workshop aims to empower people to sensitively discuss stillbirth prevention with First Nations women. Participants learn about Australia’s history and the effects of colonisation in First Nations women and birthing, as well as what culturally responsive care looks like for First Nations families.

We have a long way to go in ensuring First Nations women and families receive high-quality, culturally responsive maternity care. But formal education within maternity services is a crucial place to start.

In this article, we use the term “First Nations” to refer Aboriginal and Torres Strait Islander people in Australia. We acknowledge there is variation in preferences for the terms “First Nations”, “Indigenous” and “Aboriginal and Torres Strait Islander”.

Deanna Stuart-Butler, Indigenous Research Officer, The University of Queensland; Aleena Wojcieszek, Clinical Perinatal Epidemiologist, The University of Queensland; Sarah Graham, Epidemiologist, Mater Research Institute, The University of Queensland; Valerie Ah Chee, Indigenous Research Midwife, Stillbirth Centre of Research Excellence, The University of Queensland, and Vicki Flenady, Professor, Mater Research Institute; Director, Centre of Research Excellence in Stillbirth, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Women want to see the same health provider during pregnancy, birth and beyond

December 23, 2023 by Madeline Lucre Leave a Comment

In theory, pregnant women in Australia can choose the type of health provider they see during pregnancy, labour and after they give birth. But this is often dependent on where you live and how much you can afford in out-of-pocket costs.

While standard public hospital care is the most common in Australia, accounting for 40.9% of births, the other main options are:

GP shared care, where the woman sees her GP for some appointments (15% of births)
midwifery continuity of care in the public system, often called midwifery group practice or caseload care, where the woman sees the same midwife of team of midwives (14%)
private obstetrician care (10.6%)
private midwifery care (1.9%).

Given the choice, which model would women prefer?

New research, published BMC Pregnancy and Childbirth, found women favoured seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician.

Surveying 8,804 Australian women for the Birth Experience Study (BESt) and 2,909 provided additional comments about their model of maternity care. The respondents were representative of state and territory population breakdowns, however fewer respondents were First Nations or from culturally or linguistically diverse backgrounds.

The survey analysed comments in six categories – standard maternity care, high-risk maternity care, GP shared care, midwifery group practice, private obstetric care and private midwifery care – based on the perceived strengths and limitations for each model of care.

Overall, they found models of care that were fragmented and didn’t provide continuity through the pregnancy, birth and postnatal period (standard care, high risk care and GP shared care) were more likely to be described negatively, with more comments about limitations than strengths.

What women thought of standard maternity care in hospitals

Women who experienced standard maternity care, where they saw many different health care providers, were disappointed about having to retell their story at every appointment and said they would have preferred continuity of midwifery care.

Positive comments about this model of care were often about a midwife or doctor who went above and beyond and gave extra care within the constraints of a fragmented system.

The model of care with the highest number of comments about limitations was high-risk maternity care. For women with pregnancy complications who have their baby in the public system, this means seeing different doctors on different days.

Some respondents received conflicting advice from different doctors, and said the focus was on their complications instead of their pregnancy journey. One woman in high-risk care noted:

The experience was very impersonal, their focus was my cervix, not preparing me for birth.

Why women favoured continuity of care

Overall, there were more positive comments about models of care that provided continuity of care: private midwifery care, private obstetric care and midwifery group practice in public hospitals.

Women recognised the benefits of continuity and how this included informed decision-making and supported their choices.

The model of care with the highest number of positive comments was care from a privately practising midwife. Women felt they received the “gold standard of maternity care” when they had this model. One woman described her care as:

“Extremely personable! Home visits were like having tea with a friend but very professional. Her knowledge and empathy made me feel safe and protected. She respected all of my decisions. She reminded me often that I didn’t need her help when it came to birthing my child, but she was there if I wanted it (or did need it).”

However, this is a private model of care and women need to pay for it. So there are barriers in accessing this model of care due to the cost and the small numbers working in Australia, particularly in regional, rural and remote areas, among other barriers.

Women who had private obstetricians were also positive about their care, especially among women with medical or pregnancy complications – this type of care had the second-highest number of positive comments.

This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive.

However, one of the limitations about continuity models of care is when the woman doesn’t feel connected to her midwife or doctor. Some women who experienced this wished they had the opportunity to choose a different midwife or doctor.

What about shared care with a GP?

While shared care between the GP and hospital model of care is widely promoted in the public maternity care system as providing continuity, it had a similar number of negative comments to those who had fragmented standard hospital care.

Considering there is strong evidence about the benefits of midwifery continuity of care, and this model of care appears to be most acceptable to women, it’s time to expand access so all Australian women can access continuity of care, regardless of their location or ability to pay.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

International Day of the Midwife opinion piece – Jessica Plater

May 5, 2023 by Madeline Lucre Leave a Comment

Last year, on the International Day of the Midwife (IDM), I participated in a rally at my hospital and spoke to the media and public about the theme of IDM “100 years of progress” and the lack of progress we had seen due to neglect by the state Liberal-National government.

I spoke about how we were still fighting for fair pay, ratios and to make our babies count. I spoke about how we were trying to celebrate a wonderful and rewarding profession, but we were feeling burnt-out, over-worked and under-appreciated by an outdated system that the previous government seemed happy to ignore and would constantly tell us was working.

Yet over the last 12 months of hard campaigning with the NSW Nurses and Midwives’ Association (NSWNMA) for our right to fair pay, ratios and making our babies count, I have witnessed the public becoming more aware of the difficulties that all healthcare workers have been facing in the public healthcare system. And these difficulties aren’t new issues, these issues have been prevalent for an extended period of time but have been neglected by the former liberal government for 12 long years.

I have felt wonder at watching the public put pressure on the state candidates in the lead up to the election to make them accountable for the state of the healthcare system and the improvements it so desperately needs.

So, this year, the theme for IDM is “Together Again – from evidence to reality” which I feel will hopefully reflect the ongoing collaboration between the NSWNMA and the Labor government.

With the announcement of the “Safe Staffing Working Group” by the Labor government to look at the implementation of the safe staffing levels aka RATIOS across our hospitals and with the local branches of the NSWNMA voting ‘yes’ for our 2023 PHS Award Claim, it gives me hope that the evidence backed ratios system will start to become a reality.

While we understand that it will take time for the new safe staffing levels to become a reality, I am hopeful for the first time in a long while, that the new Labor government will keep its promise to support its nurses and midwives and the need for ratios, fair pay and to make our babies count.

– Jessica Plater, NSWNMA John Hunter Hospital & John Hunter Children’s Hospital Branch delegate and midwife

Midwives deliver unwavering support during COVID-19

May 5, 2020 by Gia Hayne Leave a Comment

Ask any midwife about their professional skills and guidance, in light of the coronavirus (COVID-19) pandemic, and you will be reminded of the evolving role midwives play in delivering babies into our world.

On this International Day of the Midwife (5 May), the NSW Nurses and Midwives’ Association (NSWNMA) is highlighting the essential contribution of midwives in response to the current public health crisis.

NSWNMA General Secretary, Brett Holmes, said midwives have risen to the challenge of supporting expectant mothers during COVID-19 and adapting their responses to protect both mums and newborns.

“The babies being born in this challenging environment are in the best possible hands because they’re being guided, supported and cared for by midwives who are determined to give them the best possible start in life,” said Mr Holmes.

“As difficult as the COVID-19 pandemic has been on so many aspects of all our lives and livelihoods, the role of midwives and the tremendous job they do in responding to the maternity care needs of mothers and babies has not wavered.

“We want to highlight the resilience of our midwifery members on this International Day of the Midwife and congratulate them on their contribution to the profession.”

NSWNMA member and midwife of 30 years, Sue, from Northern Sydney acknowledged the challenge COVID-19 has presented in delivering maternity services, but also recognised some individual benefits.

“In the current time of the pandemic, women feel more vulnerable. They have less support from family and friends and less face to face interaction with healthcare providers,” Sue said.

“As midwives, we try to fill the void as best we can and give reassurance and care. As a positive without as many visitors the mother and father have more time to bond with their babies and get to know them.”

Emma Gedge, President of NSWNMA Wollongong Hospital branch, has been a midwife for seven years and said the global pandemic had prompted a number of maternity changes but nothing midwives would shy away from.

“We have had to think of new ways to ensure mums and babies are able to access services they need. It has changed the way we can provide education as we have to move to online platforms,” said Ms Gedge.

“Midwifery is a very hands on role, from supporting birthing women to helping mums to breastfeed, so the pandemic has posed some challenges there.”