Here is mine. I did it last night.

Submission for the Maternal Health Services Review.

I write this to you as a mother of 4 children who had to travel 80 kilometres just to give birth to them.

This review is long overdue and my hope is that it makes serious inroads into the state of maternal health care in this country.

When my husband and I found out that we were expecting our first child, due to be born in early 2001, we were hoping that we would be able to birth him in our brand new local hospital, which was completed in the previous year. It was a state-of-the-art facility, complete with Maternity ward and we were excited to think that our child could be born there. Although we knew that in the ?old? hospital that the Maternity unit had been downgraded to only accept those women considered ?low risk? ? women who had no previous complications during birth and those who were multiparas (women on subsequent pregnancies), we hoped that with this new hospital it would bring a new opportunity for those women previously excluded to be able to birth there.

But we were to find out that the status quo would continue at the new hospital. This meant that I was excluded from our local hospital and that I would now have to travel a 160 kilometre round trip to the next town to see a Doctor I had never met before, in a town I didn?t frequent and give birth in a hospital far away from family. There was the vague hope that after I gave birth I would be able to travel back to my local hospital for my post-partum hospital stay, but within 6 months of my falling pregnant, even this option was taken away from me.

And even then there was no guarantee that I would give birth in this hospital. It was only a small District Hospital and could only take women after 38 weeks of gestation, women with singleton pregnancies, women with no health complications for themselves or their babies. If you were in any way considered to be ?high risk? then you were forced to travel to the NEXT hospital, which was a further 80 kilometres away.

Overall I cannot complain about my births, I had the best Doctor?s and the best Midwives, I had vaginal births and I had perfect and healthy babies and although I had some complications after one of my births, I was attended to in an extremely professional manner and quickly received the treatment I needed. But not all women are as fortunate as I and suffer terrible birth traumas that can take many years for them to fully digest and recover from.

The situation has only become more dire as the years have gone on. Not one single pregnant woman I talk to doesn?t have concerns that she will not make it to the hospital in time and fears either giving birth at home unattended or by the roadside. This raises another, separate issue, in that the husbands and partners of these labouring women are under even more pressure to get them to the hospital ?on time?.

It makes me wonder if women and their babies will have to start dying before anything is ever done about this situation. I accept that sometimes it is a staffing issue ? there just isn?t enough Doctors or Midwives in an area to run rosters. But most disgraceful of all is that often it is just Bureaucratic red tape or bungling that sees fully functioning Maternity wards either downgraded or closed.

Rural women have a right to the same quality of Maternal health care as our city sisters. We want more choices, we want access to Independent Midwives for homebirths, we want fully functioning hospital Maternity wards, and we want Birth Centres. Our choices are severely limited before we even start.

Not only do we have severely limited choices for our preferred mode of care, which currently stands at Public or Private Hospital only, we are also at the mercy of the care we have. Women who have had surgical births have no option to have a future vaginal birth (or VBAC ? Vaginal Birth After Caesarean) because none of the current care providers are willing to take it on or encourage it because it?s just too hard for them. Obstetrician?s would rather talk a woman into having another surgical birth than let her have a vaginal birth ? a birth which would see her leave hospital for home sooner, as opposed to a surgical birth which would see her in hospital for a longer stay, which then takes beds away from other women, not to mention taking up valuable theatre time which could be better used towards shortening the surgical waiting lists.

We need to move away from the Medicalised birth industry and start treating birth as the natural and normal process that it is. Australia has a disgustingly high surgical birth rate and steps need to be made to lower it. For too long Obstetricians have ruled the roost when it comes to birth and this needs to change. Of course they have their place in birth when it is complicated and needs to be medicalised, but when birth is taking place in a normal, healthy woman with a healthy baby, then there is no need for them.

Sadly though the AMA, and namely Obstetricians specifically, are at loggerheads with the natural birth movement and shun the idea that Midwives are fully capable of taking over control of birthing women and this needs to change. The choice should be given to the birthing women, not to have it dictated to them by the medical fraternity.

Medicalised birth costs this country millions of dollars each year, money which could be redirected into other health areas.

Another problem that goes hand in hand with Maternity services is the post-natal care that women in rural areas receive and basically there is none. There are Maternal Child Health Nurses for the weekly check-ups of our babies, but where is the access to qualified Lactation Consultants? The Parliamentary Inquiry into Breastfeeding last year found that there were severe issues in this area that needed addressing, but it hasn?t solved the problem. The attrition rate for Breastfeeding is very high in rural areas simply because there isn?t the backup and support needed once a Mother is home with her baby. Often the advice one receives in hospital is conflicting and can leave a new Mother, who is struggling trying to establish a breastfeeding relationship with her baby with no other option but to turn to artificial feeding of her baby ? something which can have a possible long term impact of the health of the child. Very concerning is that not all midwives are certified Lactation Consultants, so that at the most crucial time for establishing breastfeeding a women can?t even access the best person to help her.

Unlike our city counterparts, we don?t have access to Lactation Consultants that can come into our home once we leave hospital and give us the direction we need if we are struggling. All we have is access to a phone help line, which is staffed by time-starved mothers themselves and speaking to someone on the phone who could be hundreds of kilometres away isn?t conducive to helping us the way that we need it the most.

We often don?t even have access to proper care and treatment for Post Natal Depression. All we get is the Edinburgh test and there isn?t enough follow up treatment or access to qualified counsellors if we need them.

Another issue is that the sheer distances required to travel to seek care for some women mean that they put off appointments for check ups, or they simply don?t go because either the cost of travel or the distance (and often both) is too prohibitive. This means that lives are possible at stake if complications arise and remain untreated.

In the weeks before the birth some remote families have no option but to relocate to be closer to where they will give birth. This means that they then have to travel the long distance back home in the post-partum period, so it is no wonder that women are being failed by the system when they bid their farewell to the hospital and face the daunting challenge of becoming a parent with no support network once they get home.

I am part of an online Conception, Pregnancy and Parenting community forum and every single day I read of the hardships that women face when having to decide on care providers and which mode of care they want for their pregnancy and birth. It breaks my heart to read of women who cannot get into the precious few Birth Centres that there are in this country due to lack of places, of women who want a homebirth but can?t because they cannot afford it, of women who blindly trust their Obstetricians are led into the most Medialised of births ? something which can ruin all future births for them, of women who aren?t educated enough about the choices they do have, and about women heartbroken because they couldn?t establish breastfeeding.


What I would like to see changed in our Maternal health care system is;
  • Fully funded Independent Midwives to allow women to choose homebirth ? something which should be encouraged as a valid option as it lessens the burden on Hospitals ? both in regards to bed shortages which is pandemic in almost all hospitals and also freeing up time-starved medical staff.
  • Women given a choice of care models, whether it be Independent Midwife led care, Midwife led care in a hospital or birth centre setting or the medicalised mode of care led by Obstetricians.
  • More places for direct entry Midwifery at Universities. This will put more Midwives into the workforce quicker than it previously does with the current limited placements for direct entry B.Mid, meaning that those who miss out have to take the ?long road? and do their Bachelor of Nursing first.
  • Re-open closed Maternity wards as Midwife led care Birth Centres for the smaller townships. This way low risk mothers will get to give birth locally.
  • Include Lactation Consultancy as part of the B.Mid. Currently as it stands this is an ?optional extra? and what is included as part of the degree isn?t comprehensive enough. Only those that wish to pursue it further do so. It should be mandatory for Midwives to also be qualified Lactation Consultants so that new mothers get the help they deserve at the time they need it the most.
  • Access to Post Natal Depression counselling and help for those that need more intensive treatment.
We?re not asking for much and it may be too late for me, as my childbearing days are finished, but I want this for those that are to come after me, and for my Daughters. I shudder at the thought of what the Maternal health system could be like when they are giving birth to my Grandchildren.

I thank you for allowing me the opportunity to have my say on a subject that is very close to my heart.