18 OPINION
18 OPINION
8 DECEMBER 2023 ausdoc . com . au
Are we failing to deliver positive birthing experiences ?
PAGE 16 interventions will be required , a binary view of the obstetric and midwifery workforce is not helpful .
Midwives and obstetricians need to work together , not in isolation and not in competition .
We need to speak positively about each other ’ s profession .
Throughout my obstetric career , I have worked with highly skilled , caring and compassionate midwives . There should be no sides in maternity care . There should only be a centre — and that centre is the pregnant woman .
Healthcare workers , midwives and obstetricians are part of a broader healthcare system , and any improvement requires systemic change .
Maternity services need to be adequately resourced . The workforce needs to be increased and supported .
We also need support for models of continuity of care and collaborative models
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Write-off here and ideally three lines if possible please , thankyou Obitius molupienime quat im num nume sust , simus doluptas involving midwives and obstetricians .
We need to improve antenatal care during pregnancy so that women can make
informed , autonomous choices .
Women do want to know . They are not afraid of the information .
We need to explore the concept of consent , particularly in circumstances of high stress .
Maternal and neonatal morbidity and mortality are natural but no longer seen as acceptable .
To reduce these unacceptable outcomes , we have interventions that , in themselves , carry inherent risk , and often , that risk cannot be foreseen .
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If a woman plans for a vaginal birth , she cannot avoid the possibility that the baby may become distressed or stuck . She cannot avoid the possibility of instrumental delivery with all of its inherent risks , including perineal trauma . There is an alternative , which is a planned caesarean section .
The inquiry needs to put all options on the table , and then women should be supported in their choices .
We also need to explore
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All this , delivered straight to your inbox . the concept of consent , particularly in circumstances of high stress .
How do we communicate risk when someone is in pain , when their health or their baby ’ s health is at risk ?
Pregnancy has a long gestation , and we should look at opportunities during pregnancy to listen , inform and educate during the antenatal period .
The 2014 judgement in the Nadine Montgomery case in the UK is well known in medicolegal circles .
It was about a failure to explain the risks of vaginal birth in a diabetic woman of short stature with a big baby .
The obstetrician had said : “ If you were to mention shoulder dystocia to every [ diabetic ] patient , if you were to mention to any mother who faces labour that there is a very small risk of the baby dying in labour , then everyone would ask for a caesarean section , and it ’ s not in the maternal interests for women to have caesarean sections .” The judge ’ s perspective was different . “ The law on consent has progressed from doctor focused to patient focused ,” he stated .
“ The practice of medicine has moved significantly away from the idea of the paternalistic doctor who tells their patient what to do — even if this was thought to be in the patient ’ s best interests .
“ A patient is autonomous and should be supported to make decisions about their own health and to take ownership of the fact that sometimes success is uncertain and complications can occur despite the best treatment .”
Let us approach this NSW inquiry with kindness , compassion and respect for pregnant women and extend that sentiment to the doctors and midwives who care for them . Let us work together to improve the quality of communication and care for women as individuals .
We can make an effort to understand a woman ’ s context , to understand what matters to her .
After the Nadine Montgomery judgement , the Royal College of Obstetricians and Gynaecologists issued the following statement : “ After much internal discussion , we have realised that , to get this right in women ’ s health , and especially maternity , this involves much more than redoing our consent documents ; it ’ s all about the communication with our patients .”
I think we can do that in Australia , and together , we can make the experience of pregnancy and childbirth a safe and positive one for the next generation of mothers .