For info. ---------- From: Vernon at Stringybark <[EMAIL PROTECTED]> Date: Mon, 14 Jan 2002 17:55:50 +1100 To: <[EMAIL PROTECTED]> Subject: Letter re Obstetrician resignation (CT 12/1)
Dear Sir, I read with interest 'Obstetrician fed up with the hostility (CT 12/1), announcing the retirement of long-time Canberra obstetrician Heather Munro. Dr Munro gives as reasons for her decision alleged hostility from her patients, especially regarding the issue of when obstetric intervention is needed, and the spiraling costs of insurance. While there is a legitimate issue with insurance, it is extraordinary that a specialist would blame patients for a loss of work satisfaction. Obstetrics in Australia does not have a good track record in the past decade for always making appropriate decisions about the need for interventions in birth. The national caesarean rate has soared to 20 per cent of all births, and is more than double that rate in some private hospitals, despite research evidence that caesarean is riskier than vaginal birth for both mother and baby. Research evidence also demonstrated that procedures such as rupture of membranes for inducing labour and the use of episiotomy to prevent perineal tears do not improve outcomes. Yet such techniques continue to be regularly used as part of 'active management' of women's labour. At the same time maternal deaths, particularly related to caesareans, has actually been increasing according to a recent NHMRC report (2001). So it is not defensible to claim that increased intervention rates are in the interests of mothers' safety. The fact that women are increasingly questioning the need for interventions ought to be applauded and encouraged, and any obstetrician worth their salt is actively supporting women's desire to avoid interventions whenever possible. Overseas countries with the fewest maternal deaths are actually those with the lowest rates of intervention. Obstetric skills should be being saved for the small minority of women who truly need them. In Australia by contrast a majority of women experience one intervention or another in childbirth despite having normal healthy pregnancies. Dr Munro also criticizes Canberra Hospital, saying she does not like the direction the hospital is taking, and bemoaning the loss of senior obstetricians from the hospital. Canberra Hospital has been a leading institution under the direction of Professor David Ellwood in providing healthy women with alternatives to obstetric management of labour. The Hospitals' Birth Centre and Midwifery Program offer women one-on-one care with a known midwife, which research has shown to be effective in reducing women's need for obstetric interventions. The Hospital has also been recruiting younger and more recently trained obstetric specialists, who can be expected to be up to date with research evidence on appropriate use of obstetric procedures. The move to more evidence-based practice at Canberra Hospital is reflected in the statistics on intervention rates. The Department of Health Statistics (1998) show TCH as having the lowest rates of caesarean and instrumental deliveries while the private hospitals have the highest. The most effective models of maternity care from the point of view of birthing women are those in which obstetric specialists work collaboratively with the real experts in normal birth - midwives. Dr Barbara Vernon National President The Maternity Coalition PO Box 269 Lyneham ACT 2602 02 6230 2107 490 words -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
