Working to improve Australian maternity care
The Maternity Coalition: Working to improve Australian maternity care
In the last few decades, healthcare users have become more actively involved in the inner workings of our health system. Consumers of healthcare services have begun to play an important role in developing policies, lobbying for better services and advocating for change when services fail to deliver.
In this article, Maternity Coalition shares with Bub Hub readers how their organisation is working towards improving pregnancy, birth and postnatal services for women all over Australia. Find out how mothers everywhere are joining in the bid to better Australian maternity care.
Australia's maternity services have undergone a radical change over the past two decades and while initiatives such as the baby-friendly hospital initiative have borne some positive results for mothers and babies, many aspects of our maternity care system still have a lot of room for improvement.
Rural maternity units have been closing their doors at an alarming rate in the past few years, leaving mothers to dodge kangaroos and risk roadside birth on their way to the nearest maternity ward. The term 'Born in [local town]" has gone out with the sprinklers and women in rural and remote areas have been forced to relocate to larger centres - on their own sometimes for weeks on end - to have their babies while their families stay at home.
In our city hospitals, caesarean rates have increased dramatically with private hospitals sporting rates of 38.4 percent and public hospitals averaging around 26.5 percent (AIHW, 2006), way above the maximum 15% rate recommended by the World Health Organisation. And this rise has not resulted in improvements to the health of mothers and babies. In fact, the AIWH report shows a slight increase in neonatal deaths in 2004.
The rising rate of elective caesareans has placed a lot of pressure on an already struggling hospital system. Not only are surgical theatres overbooked but neonatal units are bursting at the seams. With more babies being born unnecessarily early (ie. 39 weeks or earlier), there have been more admissions of babies to intensive or special care nurseries with breathing difficulties and other complications.
This problem is directly associated with the rise in scheduled caesareans. One city-based tertiary hospital recently reported that scheduled caesareans were being performed as early as 37 weeks for no other reason than to meet demand by medical staff to get their elective caesarean mothers booked in. The same hospital experienced a dramatic rise in the rates of admission to the neonatal intensive care and special care nurseries simply because these caesareans were being performed too early.
Add to this a growing trend towards formulating policies to reduce the likelihood of litigation, the lack of adequate post-natal services and the rising rate of postnatal disorders in this country (PND is reported to be a problem for 15 percent of birthing women) and there are a lot of issues in dire need of attention by both State and Federal politicians.
With all this in mind, Maternity Coalition certainly has its work cut out. Driven by mothers and maternity service providers angry at the loss of services, the lack of care option choices within our current system and the lack of good information about birth and birth care in the wider community, Maternity Coalition is dedicated to advocating for better pregnancy, birth and postnatal services for all Australian women.
And in just 15 years, the mums and dads who have volunteered for MC have proven that they are a force to be reckoned with. Rather than back down under pressure from larger, well-funded medical lobby groups, Maternity Coalition has a stunning track record of instigating much needed changes within maternity care systems in each Australian State as well as gaining media attention on their issues. They have their sights firmly set on the Federal Government to seek wider reforms.
How MC got started
In the late 1980s, health care users were starting to make themselves heard on a policy level and several consumer health groups started to emerge, among them the Maternity Alliance (MA) in NSW and the Mothers and Midwives Action (MAMA) in Victoria. The Victorian Task Force of MA was formed in 1988, and soon separated from MA, meeting as an independent group that became MC. Maternity Coalition was incorporated in 1991.
Who we are today
Today MC represents the needs of thousands of Australian women through its various activities and by acting as an umbrella organisation for many maternity-related organisations. Major organisations MC works with include the Australian Breastfeeding Association and the Australian College of Midwives. The organisation is run entirely by volunteers who have diverse views and experiences of the maternity care system in this country.
Members include mothers who have birthed in the private and public obstetrically-oriented system, mothers who have birthed at home, mothers who have lost local services, mothers who have been denied access to services based on archaic policies, birth care practitioners such as midwives, GP-obstetricians and obstetricians, allied health professionals such as physiotherapists, childbirth educators and pregnancy support workers such as doulas and acupuncturists. Researchers and academics in sociological, medical and midwifery disciplines are also members of the organisation.
What do we do?
Maternity Coalition's primary objective is to improve maternity services for all Australian women and their families. We believe a key to reforming women's birthing services is through consumer involvement at all levels of maternity care ?from planning, managing and evaluating new models of care through to developing maternity care policies and the education and training of birth workers.
MC representatives attend meetings with Federal and State members of parliament, with hospitals and with other organisations that have an interest in maternity services and the organisation generates media around issues related to improving maternity services.
MC responds to feedback and inquiries from women all over Australia who are having difficulties accessing the care they want and need.
Independent Child birth Education Classes (Choices for Childbirth™)
MC has also forayed into the Childbirth Education scene with its Choices for Childbirth™ sessions.
Previous MC Victorian President Leslie Arnott was a passionate supporter of the Choices for Childbirth™ programme in Victoria.
"Back in the 1970s childbirth education used to be led by independent community organisations such as the Childbirth Education Association but by the 1990s childbirth education shifted from the community to the hospitals and this has left some huge gaps not only in terms of women's knowledge-base and attitudes towards birth but also in terms of building relationships with other mothers in local communities," said Arnott.
"Even though people seem to be more health aware with the plethora of information about all kinds of health issues on the internet and on the TV, birth information is still hard to access and evaluate. Misinformation is rife," she said.
Choices for Childbirth™ was established by then MC President Robin Payne in 1999 to address the gap in good birth information by offering information in a structured series of sessions on topics not commonly covered in hospital antenatal classes. The sessions were run by MC volunteer Di Diddle for five years and recently a steering committee has been established to develop Choices into a national programme.
"In Brisbane, the Chilbirth Education Association (Brisbane) is planning to run an "early bird" choices programme so that couples planning a family can access information about all their options before even getting pregnant" said Arnott.
"We're in a really exciting time of change in the childbirth education industry as more and more couples are realising the need to seek independent information regarding their birth care choices," said Arnott.
Iin 2006, MC initiated the support and education group BaBS (Birthing and Babies Support) in Box Hill, Victoria. The BaBS concept of getting local women who are either pregnant or have just had babies together over morning tea to share insights and stories is proving very popular and already other BaBS groups are sprouting up around the country.
"It's no secret that postnatal services in this country are severely lacking," said Erika Munton, national coordinator of BaBS for MC. "With BaBS we are trying to establish better support networks for women in their local communities and provide another resource for new mothers.
"We encourage midwives and student midwives to attend and help out as well as experienced mothers in the community and provide support and information in an informal way. Best of all, BaBS groups are inclusive and free to attend!"
Who seeks out our help? Who gets involved?
In the past 5 years, MC has embraced the diversity of maternity service needs like never before. While many of the families who belong to MC are indeed passionate about the benefits of midwifery-led care having either had very positive and safe birthing experiences under the care of a skilled midwife or having had negative and unsafe births with the fragmented care received in hospital, MC is not just for women who want a natural birth.
MC regularly gets inquiries from women who want to know all their birthing options and who want to be truly informed before making decisions about their care, including women who want to have an elective caesarean and cannot get support for this option in a public hospital.
"We're not in the business of telling people how or where they should give birth but we do want to raise awareness of care options that can benefit women and their families and provide resources and information that will help women make informed choices.
"We talk a lot about midwifery-led care simply because most women in this country are denied this care option. There are a lot of underlying political reasons as to why this is so and we believe women have the right to be able to access this model of care when the best available evidence shows this kind of care is not only highly beneficial but also safe and cost-effective," said Caines.
In response to demand as well as the need to represent mothers having caesareans, Caesarean Awareness Network Australia was established in 2006 as a participating organisation of the umbrella group. CANA provides advocacy and information to women who are effected by caesareans and acts as a portal to support groups around the country and evidence-based resources.
Another participating organisation is Homebirth Australia which advocates for the needs of women who would like to have a homebirth.
Perhaps the most amazing thing about this organisation is that it is run mostly by mums, some who work part-time, some who look after several children but all who are passionately working to improve Australian maternity care and birthing services for the sake of future generations of women.
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