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Office of Colleen Hartland, Greens MP for the Western Suburbs and Victorian Greens Spokesperson on Health

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Office of Colleen Hartland, Greens MP for the Western Suburbs and Victorian Greens Spokesperson on Health Office of Colleen Hartland, Greens MP for the Western Suburbs and Victorian Greens spokesperson on health April 2014 AUTHORED BY ERIN NUNAN RMIT SOCIAL WORK RESEARCH AND POLICY PLACEMENT STUDENT Maternity Care Matters 2014 Table of Contents EXECUTIVE SUMMARY 3 GLOSSARY OF TERMS 7 WHY A SUPPORTED, POSITIVE BIRTHING EXPERIENCE IS IMPORTANT 8 LACK OF BIRTH SERVICES AND CHOICES – AUSTRALIAN CONTEXT 10 NATIONAL MATERNITY SERVICES PLAN 11 MATERNITY SERVICES IN VICTORIA 12 VICTORIA’S STRATEGIC POLICY DIRECTION 12 MATERNITY SERVICES IN RURAL AND REGIONAL VICTORIA 12 THE GROWING NEED FOR MATERNITY SERVICES IN METRO MELBOURNE 13 GRAPH 1. BIRTHS IN VICTORIA 2002-2012 14 GRAPH 2. BIRTHS BY MELBOURNE METROPOLITAN REGION. 14 MELBOURNE’S MATERNITY BEDS 16 MAP 1. MATERNITY HOSPITALS ACROSS MELBOURNE METROPOLITAN AREA 16 TABLE 1. NUMBER OF MATERNITY BEDS ACROSS MELBOURNE BASED ON SUBURBS LOCALITY. 17 MATERNITY SERVICES IN MELBOURNE'S WEST 19 THE SUNSHINE HOSPITAL 19 THE WERRIBEE MERCY HOSPITAL 21 THE ROYAL WOMEN’S HOSPITAL CATCHMENT 22 THE CAPACITY OF MATERNITY SERVICES IN VICTORIA: AUDITOR GENERAL’S REPORT 2011 23 IMPACTS OF MATERNITY SERVICE SHORTFALLS 26 THE NEED FOR STRATEGIC PLANNING AND INVESTMENT IN MATERNITY SERVICES 27 MATERNITY CARE CHOICES IN VICTORIA 29 TABLE 2. MATERNITY MODELS OF CARE AVAILABILITY BASED ON MAJOR METROPOLITAN PUBLIC HOSPITALS ACROSS MELBOURNE 32 RESULTS OF OUR SURVEY 33 CONCLUSION AND RECOMMENDATIONS 37 ENDNOTES 40 2 Maternity Care Matters 2014 Executive summary Having a baby is one of the most significant events in a women's life. Getting high quality care that meets women's needs is critically important for the wellbeing of women and their baby. Unfortunately, maternity services in Victoria are currently not meeting the needs of many women. There is a shortage of services in urban growth areas, and limited access to midwife-led care and continuity of carer. Service shortfalls Victorian Auditor General, Des Pearson in 2011 found that access to maternity services in Victoria for antenatal, labour/birth and postnatal care is not equitable. In particular, women living in Melbourne’s growth areas were found to have fewer publically available services, resulting in increased costs for antenatal care and delays in accessing services. He also found shortcomings in the department’s planning approach, stating it cannot demonstrate that maternity services are provided when and where needed. Since then, there has been little demonstrative progress in this area as shortfalls in service continue to arise. With our growing population, birth numbers are rising and maternity services in urban growth areas are struggling to keep up with demand. The biggest shortfalls in services are in Melbourne’s western suburbs. Melbourne’s western suburbs have overtaken the Gold Coast as the fastest growing region in Australia, at around 8% a year. Between 2001 and 2012 there was a 70% increase in the number births in the western suburbs (increase of 5,448 births per year). With no private hospitals offering maternity services in the western suburbs, all this pressure falls on just two hospitals, the Werribee Mercy and Sunshine Hospital. This huge growth in demand has led to significant service shortfalls and difficult conditions for women. Over 200 babies were delivered in emergency at Sunshine hospital between 2006 -20111 due to a lack of birthing suites available. This shortage 3 Maternity Care Matters 2014 of maternity services in the western suburbs causes significant pressure and stress on hospital staff and resources, and can lead less time spent with midwives and doctors and thus to poorer care for some women. In recent years a number of women were turned away from Werribee Mercy Hospital as it was fully booked, leading to long travel distances and more expense. All these shortfalls can cause unnecessary stress, anxiety and cost for mothers. Currently the government operates in crisis mode, only responding with band-aid measures when there is public outcry about service shortfalls. Meanwhile, women and their children are getting a raw deal. This is simply not good enough. To meet current and future maternity needs we need strategic forward planning, with matched financial investment. Immediate action is required to address known shortfalls in service. Much of the demand created by the 70% increase in births in the western suburbs over the past decade has been met by the Sunshine Hospital. This hospital has done its best to fit new maternity beds in the existing infrastructure, but it has led to maternity wards being dispersed within the hospital. This is very challenging for staff and patients. In 2012/13, Sunshine Hospital had the second-highest number of births of any single hospital in the state, with 5,284 births2. Maternity services at Sunshine are not provided in a dedicated Women’s hospital, unlike other maternity services of that size, such as the Royal Women’s hospital or the Mercy Hospital for Women. Sunshine is also not a tertiary hospital, meaning that newborn babies needing intensive care or women with high risk pregnancies must be moved to the Royal Women’s hospital, as there are no such services in the West. Having a dedicated, purpose built tertiary hospital in Melbourne’s West with sufficient capacity to meet current need and future growth is essential. 4 Maternity Care Matters 2014 Lack of choice in care While in theory there are a range of birthing options in Victoria, the level of choice and control over the birth varies depending on how well informed a women is, where she lives and her financial means. Across Australia, less than 5% of women have the option of midwifery led care3, with less than 1% having access to one-on-one continuity of care from a midwife4. Research suggests that midwife-led care can lead to better outcomes for mothers and their babies5. Under the 2010 National Maternity Services Plan, Victoria committed to providing women-centred care that is responsive to women's needs and preference, to supporting informed choices, and improved access to a range of models of care. The Victorian Government has taken some steps towards realising this agenda; however as this report indicates there is still a way to go. Increasingly many women are seeking midwife-led care and continuity of carer, yet some hospitals, including Werribee Mercy Hospital, Northern Hospital and Monash Hospital, do not offer this type of care. Hospitals that do offer this care often have very limited places. Many women want to give birth in a birth centre or through a public homebirth program, yet with only one birth centre and two public homebirth programs in Victoria, many miss out. We can have women-centred maternity services that provide proper information and continuity of care, provide women with their choice of model of care, and provide more services where they are most needed. With the appropriate support and investment, a safe and fulfilling birth can be achieved for all women. Recommendations To improve maternity services in Victoria: 5 Maternity Care Matters 2014 1. Better monitor and respond to demand for maternity services, including developing a strategic plan to meet projected growth in birth numbers. 2. Fund construction of a tertiary Women’s Hospital in the western suburbs to address the growing shortfall in maternity services and capacity restraints at Sunshine Hospital. 3. Establish guidelines for better provision of information about maternity care and choices for women, to support women to make informed choices. 4. Support provision of increased continuity of care in all maternity services. 5. Make midwife-led care more accessible by funding the introduction of caseload or team midwifery models of care at every metropolitan and major regional hospital, and expand places at hospitals where it is currently offered and often booked out. 6. Support expansion of public homebirth programs to more hospitals. 7. Investigate the feasibility of establishing more birth centres in Victoria. 6 Maternity Care Matters 2014 Glossary of Terms Antenatal: The period between conception and the onset of labour. Caseload midwifery care: Care provided by the same public hospital midwife for the majority of antenatal, labour, birth and postnatal care. Continuity of care: Ensuring a woman receives care from the same, known provider, or small group of providers, during the pre-natal, birthing and post-natal period. Birth Centre: Midwifery care within a separate section of a hospital where midwives provide antenatal, intrapartum and postpartum care in a home-like environment. Medicare Benefits Schedule (MBS) fee: The fee reimbursed by Medicare when paying for a healthcare service. Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist. Midwifery-led care: Maternity care that is led by a midwife or team of midwives in a variety of settings. Midwifery Group Practice: term used to describe the caseload midwifery model of care, see ‘Caseload Midwifery Care’ Postnatal : The period beginning immediately after the birth of a child and extending for about six weeks. Private maternity care: Private maternity care provided in the home, private rooms or in hospital by a private midwife, obstetrician or GP obstetrician. This includes antenatal, labour and post-natal care. Shared maternity care: Formal arrangements between a local practitioner (GP, or obstetrician or midwife at community health centre) and a public hospital, in which visits to the hospital take place at the beginning and latter stages of pregnancy, but the majority of care is provided by the local practitioner. Standard care: Standard models of maternity care in hospitals are obstetrician led with midwifery support. If it is a low risk pregnancy, often a midwife will provide a majority of the care. Team midwifery care: Small teams of public hospital midwives that provide care during pregnancy, labour, birth and the hospital stay.
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