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Here is a copy of mine:
I fail to
understand why The Australian continues to publish the scare-mongering opinions
of individuals who are quite clearly not aware of the current evidence
(Midwives
invaluable, but they must be in a hospital setting,
September 03,
2005).
I choose not to work in a hospital
setting; however I do not provide midwifery services in isolation from
doctors. I am very grateful for and value the small group of GP/Obs and
Obstetricians who I can consult with if the need arises.
The women who seek my services are
looking for something that is not available to the majority of Australian women
in the current health system, continuity of a known midwife. They are well
informed and know that having a baby in hospital does NOT guarantee a safe
delivery.
I suggest
Pieter Mourik look at the perinatal outcomes for the Inuit women in remote
Inukjuak in Northern
Quebec. They are
an isolated, high risk population who are now cared for by the local midwives
in their community. Their outcomes not only improved but put many of our
Australian hospitals to shame. History is indeed their
judge!
Andrea
Bilcliff
Midwife
----- Original Message -----
Sent: Saturday, September 03, 2005 4:47
PM
Subject: [ozmidwifery] Pieter Mourik in
The Australian
Dear
all
Here is the rant in the Oz today, I think he will assist us
greatly! Interesting that re his insurance he has forgotten that taxpayers
actually
pay 80% of his premiums while midwives get no
assistance!
Also a copy of my letter to the Oz
As a mother of
4, soon to be 6, I hold the safety of my children and myself dear. Dr Mourik's
assessment of safety is little more than scare-mongering spin.
Large
Hospitals are not lined with medicos on hand for the 'what ifs' they are
overstretched with competing interests. Private Hospitals and smaller
units need to call in medical staff. Current services disregard the
appropriate roles for midwives and doctors due to a complete stranglehold by
the vested medical interests.
The safety of midwifery is established.
What is yet to be examined (due to a lack of medical
accountability) is the safety and appropriateness of the routine care the
majority of women are subjected to. In large centres women are herded
like cattle and cared for with a clock and organisational management as a
guide, rather than practices based on scientific evidence and women's choice.
In rural areas it's generally a couple of hundred kilometres dodging
kangaroos (due to no local service).
I'm glad Dr Mourik has retired
because his assertions that Drs can provide a safe service and emergency care
in an instant need full scrutiny. Examination of current routine
maternity care will reveal a sick system indeed.
Midwives
invaluable, but they must be in a hospital
setting
Peter Mourik
September 03, 2005
IT was 8am and Sally - not her real name - had been in
labour all night. She was tired but exhilarated; this was the moment she had
waited for. This was her first baby, she was healthy and had been assessed as
"low risk", so she was confident. The labour was hard, but she received all
the support she needed from her partner and the midwives, who had been
wonderful. Her labour crossed three shifts of nurses.
Now she had to push.
Suddenly, even though her baby had been frequently listened to during her
labour, the midwife found the baby's heart rate had dropped to a dangerous 60,
and stayed at 60 despite rolling Sally over and giving oxygen. The midwife
examined her and found the baby was not going to deliver quickly. The
emergency alarm was rung.
Within a minute, the visiting doctor,
fortunately doing his rounds, arrived and conferred with the midwife, then
rapidly delivered the baby with a vacuum. The umbilical cord was not only
around the neck once, but five times. The baby was sleepy, but started
breathing in one minute and was safe.
This is a true story, and not
uncommon; if this baby had been delivered in a free-standing midwife-only
unit, or at home, it would not have survived the 30-minute transfer.
Midwives cannot and should not do operative deliveries. They have not
had the training that doctors have had. Midwives cannot provide their services
in isolation from doctors, because they cannot guarantee to complete a safe
delivery.
To remove childbirth to free-standing midwife-only units, or
worse, to a home, is simply taking unnecessary risks. Women who select
themselves as "healthy" may be underestimating their risks.
In
Australia 30 per cent of women are obese, which increases all known
complications. Women are leaving their childbearing until much older, which
also increases the risk of complications. Over half the women having their
first baby fail to have a normal delivery.
Then there are other
complications, like those where the baby is too big for a natural birth, or
the cord may be around the baby's neck, strangling it during labour. The cord
cannot be detected without monitoring during labour. The baby could be
undersized or malnourished, which is difficult to detect clinically. Thirty
per cent of these babies develop acute distress in labour, requiring immediate
operative delivery.
The baby's shoulders may become stuck during
delivery, which although fortunately only happens in one in 500 births, is one
of the most dangerous and difficult deliveries experienced, immediately
needing the extra skills provided by an obstetrician. Even after normal
delivery, 5 per cent of "healthy" women have a massive bleed, rising to 15 per
cent if an injection to contract the uterus is refused. Can you imagine how
dangerous this can be in a home environment?
These complications are
what we see in developing countries, and to advocate home deliveries or
free-standing midwife-only units (with no immediate medical help close at
hand) is like going backwards in time.
Between 30 and 50 per cent of
women who choose midwife-managed births have to be transferred to a doctor she
has never met. If the woman delivers in a team model of care, immediate
medical or surgical help is available and the same midwife is able to support
the woman to the very end of delivery.
Until now, Australia has led
the world in safety in childbirth because midwives provide their services with
doctors as a team, in an environment that has immediate help at hand.
Most maternity units have "low risk" birthing units managed by
midwives, and doctors support this.
However, doctors are very
reluctant to be responsible for a complication due to a misjudged diagnosis by
a midwife in a standalone unit, when the missed diagnosis delays the transfer
of the patient. Doctors need the government to guarantee that they will not be
sued for managing the complications of a midwife-referred patient.
Midwives are not self-insured; they want the government to insure them
and then to pay them the same as doctors for managing a pregnancy, while most
doctors doing obstetrics have to personally pay huge insurance premiums. As
reported in the Weekend Australian (August 20-21, 2005), there are now
cases of midwife complications in the courts. Midwives do not have the same
training or experience as doctors and specialists. Midwives do basic nursing
training followed by a two-year midwifery course, while specialist
obstetricians do a six-year medical course, then a further six years to
qualify as a specialist. The training for doctors not comparable to midwives'.
To consider that independent midwife delivery is an improvement in the
current safety and quality of childbirth in Australia is making a huge mistake
and history, unfortunately, will be the judge.
This is a reply to a
comment by Professor Kathleen Fahy run on August 20
Pieter Mourik
is a retired obstetrician in Wodonga, NSW
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