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LATE last year, a petition did the rounds of the email inboxes of hundreds of Melbourne women. It was a call to arms — and a public relations nightmare for the Royal Women's Hospital.
The petition was a plea to save the Family Birth Centre, a "home-like" part of the hospital where babies come into the world under the care of midwives, not doctors. The centre will no longer exist when the new hospital opens in 2008.
It was too late to save the centre but the petition forced the hospital to explain itself. It insists the birth centre is "elitist" and its elements should be available to all women.
But will the new hospital actually narrow options? "To me, the birth centre is all about choice," said a centre midwife, who asked to remain anonymous. "It is about providing women with a middle ground between a hospital and a home birth."
Each year, almost 2000 Victorian mothers-to-be choose birth centres; the Royal Women's is the most popular. Across its five birthing suites, the midwives are in charge. And they are a particular breed of midwife, committed to "natural" birth and skilled in alternative pain relief.
The hospital says this service should be available to not just 65 women a month, or 15 per cent of the hospital's birthing women. Also, nearly 40 per cent of women are transferred out because of complications or if they want an epidural (painkilling injection). The hospital says this is not good — if help is required, it should come to them.
That's the official response. The context is that having babies has changed since the 1970s, when birth centres were set up. There's more litigation, more monitoring of the baby, more "medicalisation" of birth, more caesareans. Some believe that birth centres are merely tolerated by hospitals because doctors do not like midwife-led care. It could be, also, a rationalisation of services — the centre has a higher ratio of midwives to women, so staff costs are higher.
Tanya Farrell, program manager maternity services, denies this and says the hospital wants to expand the model of midwife-led care in the new building.
Royal Women's obstetrician Penny Sheehan agreed it would be hard for the birth centre midwives to "let go of their own space". But she said "we are in no way restricting their work practices or changing what the philosophy will be".
The big change will be the hospital itself. A recent artist's impression of the new hospital's postnatal rooms has them appearing like hotel suites. In half, mothers will not have to share with anyone else, and 70 per cent of these rooms will have double beds for partners to stay.
Questions remain about how the birth centre's philosophy can be spread across the hospital.
"The birth centre is not just a physical structure, it is a philosophy of care," says Sharon Licqurish, a midwifery lecturer at the Australian Catholic University. "Sure, you might have double beds in the new rooms, but it has to be followed through with the philosophy of women-led care and allowing them choice and control in their childbirth."
The Maternity Coalition, an influential interest group, has backed the hospital's plans on the proviso that it begins to roll out caseload midwifery care. This means that one midwife follows the pregnancy of one woman, right through to postnatal care.
The hospital is expected to announce today that it will set up caseload midwifery, beginning in the birth centre.
THE BABY BOON
THE BIRTHING CENTRE
■ More than 10,000 women have given birth in the centre since it opened in October 1979.
■ Provides a "safe, home-like" environment, double beds allow partners to stay overnight.
■3 8 per cent of women are transferred out to other labour wards due to a complication or if they want an epidural (painkilling injection).
■ It provides ante-natal and post-natal care.
■ The centre is run by midwives with a philosophy of birth with little medical intervention.
THE NEW HOSPITAL
■ Half of the post-natal rooms will be for one patient only, and 70 per cent of these rooms will have double beds.
■ The hospital says the maternity service will be family friendly and offer a "home-like" environment.
■ Rooms will have bigger windows, more like hotel than hospital rooms, each with en suites.
■ The 17 new birthing suites will each have a big bath and a bathroom, and 5000 babies a year will be delivered.
■ The new hospital is being built next to the Royal Melbourne Hospital, in Grattan Street, Parkville.
