PARLIAMENT OF VICTORIA Family and Community Development Committee Inquiry into perinatal services Final Report Parliament of Victoria Family and Community Development Committee Ordered to be published VICTORIAN GOVERNMENT PRINTER June 2018 PP No 402, Session 2014‑18 ISBN 978 1 925703 46 7 (print version) 978 1 925703 47 4 (PDF version) Committee functions The Family and Community Development Committee is constituted under section 11 of the Parliamentary Committees Act 2003. The Committee’s functions are to inquire into, consider and report to the Parliament on: a. any proposal, matter or thing concerned with: i. the family or the welfare of the family; ii. community development or the welfare of the community; b. the role of Government in community development and welfare, including the welfare of the family. ii Family and Community Development Committee Committee membership Mr Paul Edbrooke MP Ms Cindy McLeish MP Chair Deputy Chair Frankston Eildon Mrs Roma Britnell MP Dr Rachel Carling‑Jenkins MLC Ms Chris Couzens MP South‑West Coast Western Metropolitan Geelong Member since 22 August 2017 Ms Maree Edwards MP Mr Bernie Finn MLC Bendigo West Western Metropolitan Inquiry into perinatal services iii Committee secretariat Staff Mr Joel Hallinan, Executive Officer (from 12 February 2018) Dr Greg Gardiner, Executive Officer (until 25 January 2018) Ms Rachel Macreadie, Research Officer Dr Pamie Fung, Inquiry Officer (March to June 2018) Ms Helen Ross‑Soden, Administration Officer Committee contact details Address Family and Community Development Committee Parliament of Victoria, Spring Street EAST MELBOURNE VIC 3002 Phone 61 3 8682 2843 Email [email protected] Web http://www.parliament.vic.gov.au/fcdc This report is available on the Committee’s website. iv Family and Community Development Committee Contents Preliminaries Committee functions ii Committee membership iii Committee secretariat iv Terms of Reference xi Chair’s foreword xiii Executive summary xv Acronyms xxi Recommendations xxiii Introduction xxxiii 1 The quality and safety of perinatal services in Victoria 1 1.1 The Capability Framework for Victorian maternity and newborn services 3 1.1.1 Maternity care 3 1.1.2 Neonatal care 5 1.1.3 Neonatal intensive care units (NICU) 7 1.1.4 The impact of the Capability Framework on health services 10 1.2 The Victorian Perinatal Data Collection 13 1.3 Australian and New Zealand Neonatal Network 13 1.4 Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) 14 1.5 Hospital monitoring and accountability 16 1.5.1 Safer Care Victoria 18 1.5.2 Perinatal mortality rate 21 1.5.3 Regional perinatal mortality and morbidity committees 22 1.5.5 National Strategic Approach to Maternity Services 24 1.6 Patient transfers through PIPER 25 1.7 High risk pregnancies and their management 31 1.7.1 Premature births 31 1.7.2 Obesity 33 1.7.3 Gestational diabetes 35 1.7.4 Smoking 36 1.7.5 Drug and alcohol use 38 1.7.6 Health promotion 41 1.7.7 Caesarean sections 42 1.7.8 Inductions 44 1.8 Early discharge from maternity units 45 Inquiry into perinatal services v Contents 1.9 Support services for families 48 1.9.1 Healthy Mothers, Healthy Babies 48 1.9.2 Other programs for families 48 1.9.3 Cradle to Kinder 52 1.9.4 Child protection 53 1.9.5 Child FIRST 56 2 Models of care for mothers and their babies 57 2.1 Models of care 58 2.1.1 Choice of care 59 2.2 Continuity of care 62 2.2.1 Caseload midwifery programs 64 2.2.2 Research on continuity of care models 65 2.2.3 Continuity of care for vulnerable women 67 2.2.4 Doulas 67 2.2.5 Continuity of care and workforce issues 69 2.3 Admitting rights for private midwives in public hospitals 71 2.4 Shared care 74 2.4.1 General practitioner (GP) shared care 74 2.4.2 Midwifery‑led shared care 76 2.5 Homebirths 77 2.6 Women’s birthing rights 80 2.7 Antenatal programs for pregnant women, fathers and families 83 2.8 Breastfeeding in Victoria 86 2.8.1 Benefits of breastfeeding 86 2.8.2 Women’s experiences of breastfeeding 87 2.8.3 Victorian Breastfeeding Guidelines 90 2.9 The Baby Friendly Health Initiative 91 2.10 Barriers to breastfeeding 93 2.11 Breastfeeding organisations 95 2.11.1 Australian Breastfeeding Association 95 2.11.2 Warrnambool Breastfeeding Centre 96 2.12 Lactation consultants 97 2.12.1 Hospital lactation clinics 99 2.13 Formula marketing 102 2.13.1 The World Health Organization (WHO) Code 104 3 Perinatal mental health services 107 3.1 Societal shift in perinatal support 108 3.2 The ad hoc and unintegrated nature of perinatal mental health services 111 3.3 Australian Clinical Practice Guideline for Mental Health Care in the Perinatal Period 113 3.4 Victorian Perinatal Mental Health Plan 114 vi Family and Community Development Committee Contents 3.5 Prevalence of mental health disorders in the perinatal period 115 3.5.1 Depression 116 3.5.2 Anxiety 117 3.5.3 Post‑traumatic stress disorder 117 3.5.4 Bipolar disorder 118 3.5.5 Schizophrenia 118 3.5.6 Borderline personality disorder 118 3.5.7 Postnatal psychosis 119 3.5.8 Maternal suicide 120 3.6 Impact of mental illness during the perinatal period 122 3.6.1 Risk factors 124 3.6.2 Family violence 125 3.7 Screening during the perinatal period 129 3.7.1 Edinburgh Postnatal Depression Scale 132 3.8 Bereavement 134 3.9 Treatments and services for women 138 3.9.1 Early Parenting Centres (EPC) 138 3.9.2 Mother baby units 139 3.9.3 National helpline: Perinatal Anxiety and Depression Australia (PANDA) 141 3.9.4 Other programs 142 3.10 National Perinatal Depression Initiative 143 3.10.1 Perinatal Emotional Health Program (PEHP) 144 3.10.2 Withdrawal of NPDI funding 148 3.11 Medicare items 151 3.12 Depression and anxiety in fathers 152 3.12.1 Services and programs for fathers 154 4 Perinatal services in rural and regional Victoria 157 4.1 The disparity in perinatal outcomes between rural and regional and metropolitan Victoria 158 4.2 The experiences of rural and regional women 162 4.2.1 Separation of mothers and babies and women birthing away from home 165 4.3 Closure of birthing services 168 4.4 Pressures on the Capability Framework in rural and regional Victoria 171 4.4.1 Distance to higher capability health services 172 4.4.2 Transfer of mothers and babies to higher capability services 173 4.4.3 Rural and regional workforce issues 175 4.4.4 Facilities to meet demand 177 4.4.5 Intraregional referral pathways and support for smaller health services 178 4.5 Access to models of care and continuity of care 183 4.6 Access to perinatal mental health services in rural and regional Victoria 185 4.6.1 Impact of the loss of National Perinatal Depression Initiative funding on rural and regional perinatal mental health services 185 4.6.2 Gaps in referral pathways 186 Inquiry into perinatal services vii Contents 4.7 Attracting and retaining staff in rural and regional areas 188 4.7.1 Obstetricians and gynaecologists 189 4.7.2 GP obstetricians 190 4.7.3 Midwives and nurses 193 4.7.4 Psychologists and psychiatrists 196 4.7.5 Training in emergency obstetrics 198 4.8 Telehealth 200 4.8.1 The potential benefits of telehealth 200 4.8.2 The potential limitations of telehealth 202 4.9 Bush nursing 204 4.9.1 Swifts Creek Bush Nursing Centre 204 5 Workforce capacity in perinatal services 207 5.1 Planning for population growth 208 5.2 Rural and regional workforce 210 5.3 Midwife workforce 216 5.3.1 Midwife shortage 217 5.3.2 Midwife pathways to qualification 223 5.3.3 Midwife further training 229 5.4 Perinatal nursing workforce 232 5.4.1 Registered nurse shortage 232 5.4.2 Neonatal nurse shortage 234 5.5 Obstetricians and gynaecologists, paediatricians, general practitioners, and other specialists 236 5.6 Mental health practitioners 239 5.7 Lactation consultants 243 5.8 Genetics services providers and sonographers 244 5.8.1 Genetics services providers 244 5.8.2 Sonographers 246 6 Maternal and Child Health Service 249 6.1 Maternal and Child Health Service in Victoria 250 6.1.1 Core components 251 6.1.2 Flexible services and services in addition to the core components 255 6.1.3 Governance and funding 256 6.1.4 MCH Service App 259 6.1.5 Programs for fathers 259 6.2 Participation rates and planning for population growth 261 6.2.1 Participation rates 261 6.2.2 Planning for population growth 263 6.3 Adequacy of the Ten Key Ages and Stages consultations 264 6.4 Breastfeeding support 266 viii Family and Community Development Committee Contents 6.5 Mothers’ experiences 268 6.5.1 Focus on children, and not mothers 268 6.5.2 Continuity of care 269 6.6 Maternal and Child Health workforce 270 6.6.1 Training for Maternal and Child Health nurses 270 6.6.2 Ageing and part time workforce 275 6.7 Pathways for treatment referral 277 6.8 Impact of increasingly complicated presentations 280 6.8.1 Family violence 281 6.8.2 Low weight discharge 283 6.9 Communication between hospitals and MCH Service providers 285 6.9.1 Birth notifications 285 6.9.2 Poor communication in metropolitan areas 288 6.9.3 Good communication in rural and regional areas 289 7 Perinatal services for Aboriginal and Torres Strait Islander communities 293 7.1 Aboriginal and Torres Strait Islander women in the perinatal period 294 7.2 Aboriginal and Torres Strait Islander perinatal mortality in Victoria 295 7.3 Closing the gap 298 7.4 Barriers to accessing maternity and perinatal services 299 7.5 Intrastate transfers and transport 301 7.6 Koori Maternity Services 303 7.6.1 Koori Maternity Service minimum data set 305 7.7 Aboriginal and Torres Strait Islander birthing rooms 307 7.8 Maternal and Child Health