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SUBMISSION
ENQUIRY INTO PERINATAL SERVICES PARLIAMENT OF VICTORIA - FAMILY AND COMMUNITY DEVELOPMENT
Terms of Reference
Received from the Legislative Council on 16 September 2015:
That this house, pursuant to section 33 of the Parliamentary Committees Act 2003, requires the Family and Community
Development Committee to inquire into, consider and report no later than 30 June 2016* on the current situation relating
to the health, care and wellbeing of mothers and babies in Victoria during the perinatal period, including —
1. the availability, quality and safety of health services delivering services to women and their babies during
the perinatal period;
2. the impact that the loss of commonwealth funding (in particular, the National Perinatal Depression
Initiative) will have on Victorian hospitals and medical facilities as well as on the health and wellbeing of
Victorian families;
3. the adequacy of the number, location, distribution, quality and safety of health services capable of dealing
with high-risk and premature births in Victoria;
4. the quality, safety and effectiveness of current methods to reduce the incidence of maternal and infant
mortality and premature births;
5. access to and provision of an appropriately qualified workforce, including midwives, paediatricians,
obstetricians, general practitioners, anaesthetists, maternal and child health nurses, mental health
practitioners and lactation consultants across Victoria;
6. disparity in outcomes between rural and regional and metropolitan locations; and
7. identification of best practice.
FULL NAME: Laura M Stubbings
ARE YOU SEEKING CONFIDENTIALITY? YES / NO
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All submissions are public documents (and may be published on the Committee’s website) unless confidentiality is requested and granted by the Committee. Please note that submissions will be published on this page as they are processed by the Committee. Your name will be published with your submission, but your contact details will be removed.
PERSONAL SUBMISSION
In planning my birth, there appeared to be only two options available to me: to relinquish all power and be
part of a conveyor belt of births under time pressure in a hospital or to plan a homebirth: super-clinical or
super-alternative with no middle ground. True continuity of care was what I had wanted, but I didn’t
know how to ask for that, so I planned a homebirth because it seemed the only way to be sure I would
have my views and approach to birth respected. So much of the discussion in preparation for birth was
about how to avoid being pushed or rushed into choices within a clinical setting, specifically unnecessary
or sooner-than-needed intervention.
My waters broke early, necessitating monitoring and antibiotics during labour; my baby was born at the
Northern Hospital, Epping in the birth suite with a private midwife. This was a great outcome and as close
the homebirth experience as I was likely to have- and in fact it was the experience I had looked for, but
didn’t think existed.
Hour-long pre- and post-natal appointments gave me the space to discuss all ideas and concerns and to
feel listened to and capable to approach each stage. Post-natal support from the same midwife gave me a
sense of confidence, help establishing breastfeeding and ongoing support.
I would like to see better awareness- in the general population and in people in early pregnancy in
particular- of the options available for birth. Private midwives working together with hospitals provide an
excellent combination of personal care and availability of clinical support if a natural physiological birth
does not go to plan.
GROUP SUBMISSION - “MY MIDWIVES MELBOURNE PARENTS GROUP”
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We are a collective of parents who have engaged the services of ‘My Midwives
Melbourne’ for pregnancy, birth and postnatal midwifery care. Collectively, we all
have varied backgrounds, lifestyles and values but have all come together with this
Parents Group because we have chosen a Continuity-of-Care Midwifery model for
the birth of our children. Our group has come together to share our experiences as
Consumers of Maternity Care in Victoria.
SUMMARY OF POINTS EXPRESSED IN MEETING 11.7.17
● Options for pregnancy care are not well known by the general public
● Women have found out about Continuity-of-Care via accident, word of mouth or from friends but
the option is not well known
● Some women thought that the only option for Continuity-of-Care was to have a home birth, and
didn’t realise they could have their chosen midwife in hospital
● More public information about care options is needed
● Non-biased information regarding options for care should be given to GP’s (such public, private
midwife, private obstetrician, including statistics) and preferably with information in written
format such as handouts for patients and partners
● Department of Health should have clear and concise information on their website about the
options for care in Victoria (such public hospital, public home birth program, private hospital,
private midwife in public hospital, private midwife home birth, private obstetrician, including
statistics). Then women may have more knowledge about what options to seek out in their local
area.
● “High Risk” pregnancies have more limited and sometimes no option for Continuity-of-Care with
midwife (E.g. High BMI, pre-existing diabetes).
● The role of a Midwife and the role of an Obstetrician in pregnancy and birth care needs to be
more clearly defined to the public
● There is confusion about the role of an Obstetrician in pregnancy and birth - they are specialists
in High Risk or complicated births, not usually present for Low Risk or uncomplicated births.
● New Zealand model of care is more comprehensive, ensuring that all women have access to
Continuity-of-Care (Lead-Maternity-Carer) https://www.midwife.org.nz/in-new-
zealand/contexts-for-practice
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● Other countries that have Continuity-of-Care models across the entire health service have better
outcomes for mothers and babies. I.e. The Netherlands, Sweden.
● Rural women have much greater restriction to Continuity-of-Care models
● Rural women travel for much greater distances to access Continuity-of-Care
● Without Continuity-of-Care women often do not get enough consistent support and education in
the antenatal and postnatal period, which can lead to feeling anxious, disempowered. E.g.-
breastfeeding, caring for newborn
● No one size fits all - each person needs to be treated as an individual and not all hospital policies
will suit everyone. Need personalised care to feel empowered, respected and safe. Patient-centre
care rather than Hospital-centred care.
● Through most models of care women experience long waiting times for appointments and then
are rushed through quick appointments where they don’t get time to ask questions. As a result can
feel upset, disappointed, rushed, not listened to.
● Hospital birth classes - are often teaching resistance against “hospital system” rather than
empowerment or working as a team with care providers, this encourages fear and anxiety about
birth.
● Cochrane Review of Maternity Services concluded that “Most women should be offered
‘midwife-led continuity of care’. It provides benefits for women and babies and we have
identified no adverse effects” .http://www.cochrane.org/CD004667/PREG_midwife-led-
continuity-models-care-compared-other-models-care-women-during-pregnancy-birth-and-
early
● Continuity of Care with a known midwife has better outcomes for mothers and babies
overall
● We therefore have a moral obligation to ensure that women know about and are offered
Continuity-of-Care with a midwife
● There needs to be more Continuity-of-Care services throughout Victoria.
● Private midwife visiting-access model of care should be accessible in all hospitals so that women
can choose this model throughout Victoria without adding additional costs to the Health Service.
● Pregnancy care and birthing with a Private Midwife in a public hospital reduces the financial
strain for the hospital and relieves the physical work pressures/stress for hospital staff, ie. patient
has most of pregnancy and postnatal care outside of the hospital and brings own midwife for birth
in hospital.
● Some women have decided not to move to rural areas because they will not be able to access
midwifery Continuity-of-Care
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● Some women are going to relocate their whole family prior to birth in order to have midwifery
Continuity-of-Care
● Some women are driving much further past their closest hospital to have their own private
midwife assist with their birth in a hospital which will allow it. For this reason it would be good if
all Maternity health services give women this option.
● We need proactive change from a system point of view - rather than having a private midwife
seen as a lifestyle choice, it should be promoted as a “normal” or natural choice
● Changing public perception of birth from traumatic event to positive life event. Strong desire to
pass on positive birth stories from generation to generation.
● Public perception that women who choose to have private midwife are “Earth Mother” types
rather than all walks of life, stay-at-home-mums, professionals, artists, health-care workers, etc.
● Home birth lobby movement is perceived as radical and irresponsible in Australia, even though
statistically homebirth is safe option for low risk women. Therefore we would like to see
publicly-funded homebirth programs in Victoria.
● We need to change the language around midwifery care/homebirth to talk less about emotive
issues and more about statistics and evidence based practice.
● Being clear about the role of care providers is important, take emotions out of the conversation
and stick to facts.
● Women’s experiences of Continuity-of-Care is more family oriented. I.e - all the family are
involved, whole family supported rather than just the woman, siblings involved in care.
● Continuity of care was considered fundamental to achieving quality outcomes when models
of care evaluated in QLD (Where there are many more services that offer private midwifery
care for birth) http://www.womenandbirth.org/article/S1871-5192(17)30062-8/fulltext