BRHS provides a Level 3 Maternity Service. This means our scope of practice and model of care is based on normal birthing only. Women who require more complex care supported by a Specialist Obstetrician can have some limited parts of their support at BRHS or in other agencies in East Gippsland but will plan to birth up the line in Gippsland or in Melbourne.
The way we ensure that women receive the care and support that is needed and fit the criteria for normal birth is by a model of care which includes an assessment and has monitoring processes in place. The current model of care is relatively new, having been in place for twelve months. I have noted that there has been some commentary about the standard of this new model of care that is erroneous and unwarranted. Prior to the new model being introduced, only 70 women out of 340+ had a known midwife. We reallocated our resources and worked with the GP Obstetricians and developed a model that provided more equitable access to midwives and more choice. Whilst some women who were clients of the previous My Midwife Program were not supportive of this change, concerns about safety, equity and working within our scope of practice was a greater priority.
Since the change in the model of care, we have had a significant reduction in caesarean sections and post-partum bleeds. Over 70% of the women have been birthed by a known midwife and there has been better collaboration between the GPO’s and the midwives. Our credentials in providing choice are clear within our model and we are one of the very few health services in Victoria that still offer a water birth.
We have had an external audit pre and post the changes to the model of care and I am pleased to say that our assessments have 100% compliance to the normal birth standard and our scope of practice. This is very important in the context related to concerns about the safety of birthing services across the State. We try to be compassionate and person-centred whilst still ensuring the process is safe and prevents avoidable maternal and perinatal mortality and morbidity. Even normal birth can have some unexpected outcomes and our audit indicated that when the unexpected does occur our clinical staff all knew what to do and followed the correct processes.
Concern has been voiced that we had not contacted women directly about our decision but we do not know who you are as we have not had this direct communication.
We do not have, nor have we been asked to have, a collaborative arrangement with an independent/private midwife operating in our community. It is important that women who are choosing to take this option of support understand that we still need to ensure that women that are to deliver at BRHS still meet the criteria for a normal birth and that the GPO and midwives that will be part of the birth process have confidence that they have full knowledge of all clinical and general health issues and the birthing goals. In addition, one of the clear principles of our model is that women will have the support of a known midwife. This is not possible if women are not engaging with the model and then expect a midwife or GPO to provide a holistic and positive experience for the woman.
The role of the support person is to provide emotional and simple physical support, providing information or suggesting things the woman may have learnt at antenatal classes and advocacy to ensure the birthing goals/plan are followed. In the issue discussed at the moment we have grave concern that some woman use words such as “my private midwife can’t attend” and then discuss activities that only a midwife should be involved with which is outside the role of the support person. There is not a private midwife in Bairnsdale that is credentialed to provide birthing services at BRHS and we have not had a request to credential any private midwife for this purpose.
We suggest that women who want to employ the services of a private midwife undertake their own due diligence related to the registration and right to practice, and evidence of the collaborative arrangements with a GP or GPO that entitle them to bill, and the status of their insurance.