Midwives Should Call on Obstetricians Only When They're Needed?

The Queensland arm of the Australian Medical Association is showing an appalling disregard of evidence and is telling a story that's starting to wear thin on even the most tolerant of midwives.

Dr Chris Zappala – a sleep specialist – is head of the AMA in Queensland and is spending a large proportion of his time spruiking that midwives throughout Queensland are working without obstetrician supervision or input and this is leading to newborn deaths. This message is wrong.
Why is this message getting so much air time?

And why is Dr Zappala willing to spruik his message to the public, but unable to justify his position when asked about it by an independent facilitator at a recent day-long summit with over a hundred lead obstetricians, midwives, health professionals and politicians in Queensland?  He would not state his case in front of those who could actually speak to it with authority.

The maternity system in Queensland is under pressure, but the newborn deaths have nothing to do with obstetricians being included or excluded.  The models that Dr Zappala speaks of, where midwives "exclude" obstetricians, simply do not exist.  Midwives are regulated by the same regulator as doctors to provide care to women on their own authority.

That means that midwives are required to seek medical help when additional medical help is required and can provide care for normal births when additional medical care is not required.

This is the way midwives have always provided care, and it is the way the whole system has been working for decades.

Obstetricians do need to step in when they are needed. So do anaesthetists, paediatricians, orthopaedic surgeons and ER doctors, in fact that is the basis of the medical system.

In order for women to be informed properly, we need the "real" evidence – the highest-level evidence – to be given air time.

The Cochrane database demonstrates that women are safest with a known midwife, safer than in obstetric care in 16 trials of over 17,000 women.

The Lancet describes Australia as a country moving into the "too much too soon" model of maternity care, which is causing rising rates of intervention without benefit to women and recommends pairing that level of intervention back.

This is the sort of information and research based data that our community needs in order to make well informed decisions about their maternity health care.

We need to hear the truth.

Liz Wilkes is the founder of My Midwives, an Adjunct Associate Professor at Griffith University and media spokesperson for Midwives Australia.  She has been a midwife in the public and private sector for over 20 years.

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