A positive story for once!
Sun-Herald, Sydney August 3 2003
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More power to midwives in bid to cut caesareans
By Miranda Wood, Health Reporter
Midwives at Sydney hospitals are working on a program to reduce the high rates of caesareans and other interventions during birth.
The new model of care, expected to be trialled in northern Sydney hospitals, involves a woman having the same midwife throughout pregnancy and birth.
As part of the changes, doctors are not required to be on duty, but midwives and expectant mothers can still request their assistance when necessary.
The proposed plan comes as a new Sydney study, published in this month's British Journal Of Obstetrics And Gynaecology, has revealed midwives are a cheaper
alternative to interventions during labour.
Nearly one in four NSW women has a caesarean birth, but the World Health Organisation recommends no higher than 15 per cent.
Sally Tracy, the study's author and midwifery practice development associate professor at the University of Technology, Sydney, said midwife-only births were far more
cost-effective for the health system.
"The paper is probably showing that, for the first time, we can now actually cost up the sort of things we can prevent happening in childbirth," she said.
NSW Health supports the new maternity program, which gives more power and autonomy to midwives.
A spokeswoman said: "The NSW Health department supports area health services in their development and implementation of best practice maternity care options,
which may include midwifery models of care that are provided in conjunction with other maternity health professionals."
Professor Tracy said evidence from other countries, including New Zealand, proved the proposed plan decreased the number of interventions.
"There is the research around to show that the biggest factors that prevent women from going on and having their baby quite naturally are the fear and giving birth
among people they don't know," she said.
"They've not had the continuity of having a midwife whom they know and can form a relationship with and can actually contact when they want to know the answer to
anything.
"When they come in to give birth, they know that the midwife is there and will be there with them and that, it seems, is the thing that lowers the intervention rate.
"We're looking at a better outcome for women and babies."
Professor Tracy said midwife-only births could reduce the number of interventions to between 7 and 10 per cent.
"If a woman shows any sign of having a complicated pregnancy or birth, then the lines are all open for that communication with the next level of care," she said.
Professor Tracy said an assigned midwife could also conduct home visits to assist mothers after birth.
The new plan needs approval from the body that monitors childbirth safety in NSW, the Maternal and Perinatal Committee.
Interventions include caesareans, epidurals and inductions, which must all be performed by doctors.
Professor Tracy said some doctors still had "very entrenched thinking" that women needed high-tech obstetric care.
"There is still a thinking out there that every birth is high-risk," she said.
Shellharbour Hospital, on the NSW south-coast, is also planning to introduce midwife-only births to cope with a shortage of obstetricians.
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