identify areas for improvement .

Now that the inquiry has begun ,

as commonly happens , much of the

language has been inflammatory and

damaging .

The age-old turf war over women ’ s

Dr Vijay Roach Obstetrician and gynaecologist , and former president of RANZCOG .

bodies has raised its ugly head . Terms such as “ obstetric violence ” set an agenda that casts obstetricians

Doctors can help to minimise birth trauma .

as perpetrators . We are seeing midwives and doctors being pilloried in the mainstream and social media . Health professionals are rarely good media performers , and much of what is being said is misunderstood

or misquoted .

That is why the discussion needs to begin with a genuine acknowledgement of women ’ s pain and suffering in childbirth .

Before we even arrive at why , we must accept an uncomfortable truth .

For many women , the experience of their pregnancy and care during birth has traumatised them . That is what they feel . That is their reality .

NSW Health has already acknowledged this with an apology .

On more than one occasion in my own obstetric career , I have also acknowledged and apologised for the impact of birth on my patient .

Sometimes , there was no other option : a distressed baby , a woman with severe blood loss , a labour that

but for the woman , it was not .

Sometimes , there were physical injuries with short- and long-term sequelae .

Sometimes , my communication was inadequate .

Care in pregnancy and childbirth is a unique part of the health ecosystem . It is not just about hard outcomes , life and death .

It is also about a woman ’ s journey , physically and emotionally ; about becoming a mother ; about her body . Those who have suffered , and those who are still suffering , need to

2023 , maternal mortality and severe morbidity are daily realities . It is important that we understand that . Without good antenatal care , without access to medicines , instrumental

delivery and caesarean sections , without skilled birth attendants , obstetricians and midwives ,

Terms such as ‘ obstetric violence ’ set an agenda that casts obstetricians as perpetrators .

medical system means that the benchmark is different . Our maternal and neonatal mortalities are among the lowest in the world . We are a highly resourced country with excellent

midwifery and obstetric care . That does not mean we should rest on our laurels or assume everything

There has been little opportunity for nuanced discussion .

Demonising doctors and midwives will not improve outcomes for women .

The entire healthcare workforce in Australia , and around the world , is smashed . Obstetricians and midwives are leaving the profession . Maternity units are closing , particularly in rural and remote areas .

As the inquiry progresses , it is essential that those guiding the process call for respectful dialogue .

Our care can be improved . Our communication can be improved . We can listen more .

But let us start with the premise that obstetricians and midwives are healthcare workers whose primary motivation is to care for pregnant women and their babies . There is no other agenda . Obstetricians — the majority of whom are women — are too easily characterised as interventionists , medicalising a natural process . There is also the narrative

was not progressing .

be heard and listened to — and then

women and babies are injured and

is fine . Rather , a baseline of excel-

that midwives are the custodi-

Sometimes , when viewed through

we need to do better .

die .

lent outcomes in some end points

ans of normal birth . Given that , for

a medical lens , everything was okay ,

In many parts of the world , even in

In Australia , a highly resourced

provides us with the opportunity to

some women , medical

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