Australia is fortunate that it is one of the safest countries in the world in which to give birth or be born. Australian women and their babies enjoy a system of high quality maternity care.

Professor Barclay et al (Crikey, Wednesday 19 November, item 4 “Maternity health reform has harmed women (but not obstetricians)” lament the supposed adverse outcomes associated with taxpayer supported private obstetric care in Australia and quite outrageously suggest that the system currently in place has increased suffering and injury to women and infants and led to obstetricians earning ‘millions of dollars’ a year from women who do not need their (obstetricians’) care. These comments cannot go unchallenged, because they are wrong.

Despite some of the claims made by Barclay et al, current maternity care consistently provides good outcomes, measured by any number of perinatal statistics. As referred to in Health Minister Roxon’s recent ‘Improving Maternity Services in Australia‘ document, data from the Organisation for Economic Cooperation and Development (OECD) shows that over the past decade Australia has had consistently lower maternal and perinatal death rates than the majority of comparable countries.

Barclay et al made comment on private practice obstetricians charging fees in excess of $20,000. We are unaware of any such practices and reject this. Generally, the public hospital maternity care system is already operating to full capacity and cannot possibly cope with the 30 per cent of women who currently access private obstetric care. Thus, it is imperative that the both private and public systems are well-resourced and operate side by side to provide quality care and choice for women.

Despite Barclay (et al)’s claims about private obstetric care, it is this model of care that consistently rates highest in terms of maternal satisfaction with their care, in numerous surveys.

We are at a pivotal and exciting time in the delivery of maternity care with the Federal Government’s commitment to review and improve maternity services in this country. It is hoped that as a result of the review, there will be lasting improvements made to the provision of care and training of the maternity workforce.

The high standards of professional care provided by obstetricians working in both the public and private system, is a major contributor to our current enviable safety record. Without the provision of obstetric care provided by obstetricians working in both private and public practice, Australia would not be the safe place that it now is for pregnancy and birth. In countries where obstetric care has been restricted, or has been directed towards sole practitioner midwives, there has been no reduction in costs of care nor in interventions such as caesarean section. Unlike Barclay, we would argue that women do need the care of an obstetrician, working in cooperation with other maternity service providers in a multidisciplinary team to provide the maximum choice and the best possible care. Fortunately, most obstetricians are very committed to working collaboratively with the other key caregivers in maternity services to ensure a high level of care that is safe, women-centred and culturally appropriate.

That is not to say that there is no room for improvement, especially in care of remote, rural and Indigenous women and care of women postnatally. We need to urgently consider changes to work practices in maternity care to maximise the potential and skill sets of the whole maternity workforce.

For Australia to keep what is good and address what is not, we need to continuously evaluate what we are doing and identify ways to not only maintain, but improve the standard of care we offer pregnant women and their babies. It is vitally important that the outcomes of any changes to care provision are able to be accurately measured and assessed, to make sure that we are improving things, not increasing morbidity and mortality.

We congratulate the Federal Government and in particular Health Minister Nicola Roxon, for their commitment to reviewing and improving this essential service so that every mother and her new-born, no matter where they live, receives the best possible care.

See the RANZCOG submission to the review here.

Peter Fray

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Peter Fray
Editor-in-chief of Crikey

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