July 2004

New blueprint for maternity services

The Government will give Victorian mums-to-be more choice, including increased access to midwifery care, as part of a new blueprint for maternity services across the State.

Health Minister Bronwyn Pike said the new focus on midwife-managed care, otherwise known as primary maternity services, was a response to calls from Victorian mothers for the health system to provide more birthing options.

‘The move to establish primary birthing services is what Victorian women have been asking for.

‘For the 60 per cent of women who have an uncomplicated pregnancy, a primary maternity service will be an attractive option.

‘A primary maternity service includes one-on-one support with the same midwife from the start of pregnancy to the postnatal care period.

‘Midwives are also trained to deal with a wide set of experiences encountered during pregnancy, including social and psychological issues.’

Under the system, which has been successfully introduced in other states and overseas, most hospitals which choose to develop a midwife-led birthing model will also maintain a doctor-led birthing model a well.

‘Overseas and interstate experience has shown that it is safe to offer birthing services, without a doctor in attendance, to a significant group of women with uncomplicated pregnancies—all within a system that provides appropriate medical back-up.’

Ms Pike said that because most hospitals would offer two streams, mums-to-be without complicated pregnancies would be able to choose, while remaining at their local hospital.

‘No hospital will be forced to adopt this model and no mother will be forced to have a midwife-led birth—this is all about choice.’

Ms Pike said that whether a hospital decided to offer one birthing stream or two, a strict set of conditions would be applied to ensure no mother was put at risk.

‘Already, 40 per cent of Victorian babies are born without a doctor present.

‘As part of the new blueprint, a mother will have exactly the level of care she needs.

‘If the kind of care she needs changes, she will have immediate access to higher-level services.

‘If there is the remotest chance adequate support and backup will not be available—whether that’s a doctor in the next ward or obstetrician in a nearby regional city—the midwife-led service will not be established.’

Ms Pike said safety would be further boosted by the establishment of a new emergency response service, PERS (Perinatal Emergency Referral Service) which would provide specialist clinical assistance and transfer to a secondary or tertiary hospital.

The Government has allocated $500,000 a year to the service.

The Government will also spend $450,000 training doctors and midwives in how to provide the best level of care as part of a primary maternity service.

For new primary maternity services, guidelines and accreditation procedures would also be put in place by the Victorian Maternity Services Advisory Committee, chaired by Professor Jeremy Oats, who is also the Medical Director of Obstetrics at the Royal Women’s Hospital.

Ms Pike said the introduction of the new services might also alleviate workforce problems caused by a worldwide shortage of medical specialists such as obstetricians and anaesthetists.

‘One of my main priorities is keeping services as close as possible to the communities in which women live–and this is especially so when it comes to rural women.’

Ms Pike said the blueprint would foster a team-based approach to primary maternity services.

‘While this new direction will increase the role of midwives as consistent carers, they will work as a team with local GPs and, where possible, local obstetricians.’

Supporting the new initiative, Professor Oats, said: ‘It is the teamwork between these professionals that provides the safe and supportive birthing experience.’

As part of the new system, secondary and tertiary services would sit on top of primary services.

Secondary services—mainly situated in major suburban and regional hospitals—would provide higher levels of medical care for mothers who experienced or expected some level of complication, such as high blood pressure.

Tertiary services at major city hospitals would provide hospital and specialist care for more complex concerns.