Birth Support Bendigo

Current Political news items.

Birth Support Bendigo is a community based, not for profit, incorporated body, with the aims of supporting women to birth naturally; and to make informed choices concerning pregnancy, childbirth and motherhood.

This includes providing childbirth information, resources, linkages and support in natural childbirth options within the region of Central Victoria and beyond.
We are finding it increasingly difficult to help women and families seeking natural childbirth, due to the current crisis facing Central Victoria’s maternity services, in Bendigo in particular.

We are writing to you, as Birth Support Bendigo representatives, to request a meeting with you to discuss this vital women’s health issue in detail. We seek your support in making some fundamental changes to maternity services within our region, which will increase women’s pregnancy, birthing and postnatal care options and provide better outcomes for mothers and their newborn babes.
We can provide you with some background information on this issue at your request. If not we can present this to you when we meet.Please contact any of the below members to organise a suitable time to meet.

Jane Cameron (Coordinator)
Robyn Trainor (Secretary)
Helen Ashwell (Journal Editorial coletive)

In anticipation of your response Jane Cameron Background information, Current situation. Key changes required to improve maternity services in our region. Key elements of a community midwifery program.
Experiential evidence from a local perspective. (local birth stories, midwives stories etc.) Appendix. (World health organisation, Rocking the cradle etc.) Current Situation. Maternity services within our region are currently in crisis.

Women’s choices in childbirth have been eroded and are under constant threat, as is the quality of the service they receive during pregnancy, childbirth and in the postpartum period.
This is particularly so in Bendigo, due to a number of factors:
Midwives in private practice no longer have access to indemnity insurance. Midwives in private practice (MIPP) lost their indemnity insurance during September 2001. There has been no foreseeable solution to this problem to date.
Bendigo and close communities have had a history of using independent midwives in far greater numbers than anywhere else in Australia.

Now, mostly, this service is no longer available to women and families, unless women are able to secure the service of an uninsured Melbourne based midwife. This is at considerable extra expense to families and it is certainly not the idea situation when a midwife has to travel up to 2 ½ hours to get to her client.
For women wanting to have a midwife in private practice as their primary caregiver throughout their pregnancy, birth and postnatally (be it in hospital or at home) this simply is no longer an accessible choice.
Our local public hospital (Bendigo Base Hospital) is experiencing ongoing problems within its maternity unit.

Bendigo Base Hospital (BBH) is having ongoing industrial disputes with its maternity staff. These disputes have not arisen over conditions of pay, but because many of the midwives working in the unit have great concerns over the level of staffing and the constant threatened closure of birthing suites, which has resulted in, in their opinion (include here a quote from the Bendigo advertiser or from t.v. interview), a diminished level of care being offered to the people who use their service. BBH offers women a medical model of care rather than a holistic, wellness model.

Levels of intervention at BBH are unacceptably high according to the 2000 Senate inquiry into childbirth practices in Australia (Rocking the Cradle) and the World Health Organisation. Currently our local hospital is recording a caesarean rate of 21% and rising.
By contrast, Caesarean rates in Holland are 6% and in the United Kingdom 12%.

It is of a real concern that BBH is failing to not only acknowledge that it has unacceptably high levels of intervention, but that it has no plan on how to deal with this problem.
This problem is not inclusive of BBH, but is an irrefutable part of birthing culture in our country.
The Rocking the cradle inquiry stated that:In 1996, 22.2% of women had their labour induced. The current rate is more than double the World Health Organisation goal of 10%. Some of the interventions performed during childbirth are minimal, but evidence to the Committee suggests that close to 90% of all births in Australia include some form of intervention.

The Committee was advised that once an intervention occurs it is likely to be followed by others as a consequence of the ‘cascade of intervention’ referred to earlier.
The culture of intervention in childbirth is now so pervasive that, it was suggested to the Committee, women requesting an intervention free birth were likely to receive a much less sympathetic hearing than those who requested some form of intervention.

The double birthing units at the BBH are currently being threatened with closure (Bendigo Advertiser, Feb 2001). This will effectively force women to birth in rooms designed for complicated births that require medical management.
These rooms are limited in their scope for women to birth actively and naturally. Currently Bendigo region has no Birthing centre facilities which women in Melbourne who have a low risk pregnancy can access, greatly increasing their birthing choices. Bendigo has no provision for midwives being the primary, continuous caregiver. A model proven worldwide to have the most positive outcomes for mothers and newborns.

The Rocking the cradle senate inquiry also stated:
The most significant determinant of intervention in childbirth is the type of care provided during birth and the background of the principal carer. For every form of intervention, rates are lowest where midwives are the principal carers, higher where general practitioners are the principal carers and highest where specialist obstetricians have this role.
Again, the differences can be partly explained by the nature of the client group. Specialists attend women at highest risk and midwives those at least risk. Even allowing for these differences however, there is a clear association between type of carer and number of interventions.
This point was also highlighted by the World Health Organisation recommendations in its 1999 Care in Normal Birth report. It states:Where possible, the caregiver should aim at providing continuity of care during pregnancy, childbirth and post partum period.

The midwife appears to be the most appropriate and cost effective type of health care provider to be assigned to the care of normal pregnancy and normal birth, including risk assessment and the recognition of complications.
Midwives are the most appropriate primary health care provider to be assigned to the care of normal birth.
All of these factors, when combined, have resulted in a lack and loss of choice for women and families in our region. The level of care that women can access is far from ideal.
Our region is in crisis and needs to find a solution. Delays in finding a solution are putting the health of women and babies in jeopardy. Key changes required to improve maternity services within the Bendigo region. For Women to have the greatest opportunity to experience an empowering and/or natural childbirth many changes need to be made to the services currently being offered within our region.

Birth Support Bendigo has identified these as: The availability and choice of a known midwife as a primary caregiver, throughout pregnancy, childbirth and in the early postpartum period. Midwives in independent practice having access to appropriate and affordable indemnity insurance.
Fundamental changes being made to the way BBH manages and supports pregnant and birthing women, in particular addressing its interventions rates and medicalization of childbirth practices.
Consumers and advocate groups for maternity services being consulted as to changes that are currently being suggested at the BBH, in particular how we as consumers and advocates would ideally like to see maternity services implemented.
The development and implementation of a Community midwifery program within the region of Bendigo.

Key elements of community based midwifery programs.
Birth Support Bendigo strongly feels that the implementation of a community midwifery program would offer the best solution to the outlined problems existing within maternity services in the Bendigo region.
It would offer local women and families greater choices in care throughout pregnancy, childbirth and in the postpartum period. It would offer a holistic, wellness model of care and provide women with a known midwife as their primary caregiver.
It would greatly enhance women’s ability to experience a natural childbirth and successful breastfeeding. Both of which can have a profoundly positive impact on adjusting to parenthood.

The primary principle of community based midwifery is that it is women centred, and, community managed.
Women centred care incorporates a holistic approach that takes account of each woman’s physical, emotional, familial and cultural needs.
Community management is an integral aspect of community based programs, incorporating the principles and aims of social models of health and ensuring ongoing input from a range of community members in conjunction with health care professionals.

For community based midwifery programs to succeed it is essential that they are managed and administered by people who regard pregnancy and childbirth as a normal life event and recognise the potential of birth experiences to affect not only mother, child and the immediate family, but also the broader community.
Experiential evidence from a local perspective.
The following personal birthing accounts are all from local women who employed an independent midwife to be their carer throughout their pregnancies, child birth and in the early post partum period. It is experiential evidence of the profound impact having an empowering and/or natural childbirth experience can have not only on mother’s and newborns, but on the whole family.