Transcript
Tegan Taylor: Australia is one of the safest places in the world to give birth, and yet our health system sometimes fails women and their families, and the professionals who provide support. The type of maternity care you receive can be a game of chance, and depend largely on where you live and your ability to navigate the health system. The ABC recently launched The Birth Project, an investigation into birth and maternity care in Australia. And one of the key people involved in the project is my science unit colleague, Olivia Willis. Hi, Liv.
Olivia Willis: Hi, Tegan.
Tegan Taylor: So it’s been three-ish weeks since the project launched, you’re asking people to tell you their experiences, and you’ve received thousands of responses so far. What kind of things are people telling you?
Olivia Willis: Yeah, we have, we’ve been really overwhelmed by the number of people who have gotten in touch to share their experience. And it’s a combination, I should say, of women themselves who have given birth and also healthcare professionals who work in the maternity space, we’re wanting to hear from both of them. In terms of what we’re hearing from people who are pregnant or have given birth, it’s really a bit of a mixed bag. There are certainly some stories of people who have had excellent care.
So we’ve heard, for example, from a lot of women who have gone through midwifery group practice programs where they basically see the same midwife throughout their pregnancy and birth, and many of them have had a really positive experience. But we’ve also received a significant number of responses from people who have had pretty poor experiences in the maternity system, and in some cases have emerged from childbirth feeling quite traumatised by the experience. And there seems to be a few different factors that are contributing to that. So for some women it may be that they sustained physical birth injuries and struggled to recover from that. For others, they felt like they may have had medical intervention that wasn’t entirely necessary or that they didn’t really consent to. Or conversely, they didn’t receive adequate pain relief when they asked for it. So it varies a little bit in terms of what’s causing that birth trauma, but I guess the consistent theme is women not feeling heard or respected or not feeling in control of what happened to them during their birth.
And I guess the other key thing we’re hearing a lot is issues around postpartum care. So, women feeling a bit unsupported, perhaps struggling with breastfeeding or their mental health or their recovery from birth, and really struggling to get support, either when they’re in hospital soon after they’ve given birth, or once they’re back in the community, because we know that the public health system in particular is pretty stretched. So we’re getting a picture, I suppose, of a system that seems to be under pressure.
Tegan Taylor: Yeah, you mentioned the public health system feeling stretched, and it seems like in Australia we’ve got such a good healthcare system, some people have excellent care in public hospitals…is it simply a question of just if you can pay for it, it’s better?
Olivia Willis: No, not at all. And maternity care really varies. It’s like a lot of parts of the health system, it can be a bit of a postcode lottery, and the type of care you get can depend on where you live, it can depend on how much money you’ve got if you want to access private care, but it’s also influenced by things like your own health literacy, how good you are at navigating the health system.
So a good example is something like continuity of care. So essentially what that means is you have one person who provides the majority of care throughout your pregnancy, birth and postpartum periods, so you really get to know them, they get to know you. In the public system, continuity of care is mostly with a midwife, and that’s provided in something called a midwifery group practice program or caseload midwifery, which I mentioned a bit earlier. And research shows us that this type of care is associated with lower rates of intervention, lower risk of preterm birth, less early stillbirth, and generally higher rates of satisfaction. So it’s generally the preferred model of care.
The issue is in the public system, it’s actually really hard to access this type of care. And it’s actually why some people opt to go private, is simply just so they can see the same provider throughout their pregnancy and birth, whether that’s an obstetrician usually, or sometimes a private midwife.
But in the public system, only about 30% of models actually offer that continuity. And maternal health experts say the proportion of women accessing that care is probably even smaller, somewhere around 15%. So these programs end up being really, really competitive. And whether you can get into one really depends on where you live and if by chance they have a spot available, and the waiting lists are typically very long.
Tegan Taylor: Yeah, we’ll actually have more on continuity of care and what that model could look like Australia-wide later in the show. What about medical interventions? Because we do hear a lot about caesarean rates, that sort of seems to be a bit of a marker. Does that vary across public and private or what are people telling you?
Olivia Willis: Yeah, look, it’s a pretty polarising discussion, rates of medical intervention, and it’s certainly something that we’ve seen come up a lot in the responses that we’ve received so far. So, as you mentioned, and for a bit of context, rates of medical intervention during birth have increased quite substantially in the last couple of decades. So in Australia, about 37% of women who give birth will do so via C-section, and that half of first-time mums will be induced, and both those rates have nearly doubled really, in the past two decades.
And I guess it’s important to say that there’s no doubt that those interventions can be absolutely life-saving when they’re needed, but I suppose there are questions around whether they are always needed and whether they’re being used in some circumstances unnecessarily. And from the conversations I’ve had, there seems to be a real divide, I suppose, amongst healthcare professionals, particularly between obstetricians and midwives, not always but sometimes, about what the best balance is to strike between protecting physiological birth and offering medical interventions. And the tension is really about whether that balance we’ve got is right, or we’re moving too far towards intervention.
So, when you talk to obstetricians they’ll often say that rates of intervention are going up because pregnancies are increasingly complex, we’ve got a higher proportion of women who are overweight or have diabetes, sometimes that requires more intervention. Women are having babies a little bit later. And also choice and preference, you know, there’s an increased awareness about some of the risks of vaginal birth, and so for some people they may choose to have a C-section, for example.
On the flip side we’ve got midwives who often point out that those increases in intervention don’t necessarily correspond to an increase in pregnancy risks. So there are other factors that are kind of non-medical that might be influencing that increase. And I guess they point out that we’re not necessarily seeing huge improvements in maternal and newborn outcomes, despite that increase in intervention. So it’s a really tricky space, and there are different understandings of the risks and benefits.
Tegan Taylor: Liv, thanks so much for joining us.
Olivia Willis: Pleasure.
Tegan Taylor: I can’t wait to hear more about The Birth Project down the track. Olivia Willis is a health reporter in the ABC science unit. If you want to check out The Birth Project or add your story, you can go to abc.net.au/birthproject. They really want to hear from more obstetricians.
