Evidence Based Care

Evidence Based Care

In my office at AMA (NSW) for the past 19 years there has been a framed cover of NSW Doctor. The headline on the cover says, “Who will be left holding the baby” and the photo is of a very cute, very new baby. The baby is my now 19-year-old son Tom as a literal newborn. The story was about midwife led obstetric units, two of which had just opened in NSW, one at Ryde and one at Belmont.

I have been thinking a lot about that cover because at the moment, it feels like the NSW hospital system has been dramatically catapulted back to the early 2000s, complete with the vitriol and of course, the revisiting of the greatest hits of battles around task substitution and birthing.

Those who lived through the early 2000s in the NSW hospital system will remember it was not great. It was routine for people to assume that is was not safe to get healthcare in NSW hospitals.

Following the AMA’s concerns about the establishment of 2 stand-alone midwife led obstetric units, the then Minister for Health asked us to visit them, which I did along with then President John Gullotta and obstetrician Andrew Pesce. My vivid recollection of the trip was being informed that a water birth was not “underwater” it was through water. I nodded politely.

We are incredibly fortune in Australia and NSW to have some of the best outcome measures for obstetrics in the world. Like all successful public health measures, this results in an expectation that having a baby will conform to the expectations we have for the rest of our life – an Instagram worthy moment where the birth plan is followed, and we all live happily ever after. Those working in obstetrics know this is not always the case.

While we should always be looking to improve our healthcare system, NSW has an excellent, women-centred model of healthcare. We know that in regional and rural areas, this model is struggling due to lack of workforce, and we need to look at this.

However, we need to consider models of obstetric care based on evidence, not emotion. We need to be mindful of the outcomes of the Ockenden review in the UK which demonstrated the terrible tragedy that comes when we don’t build healthcare models which place the health of the mother and the baby at the centre. We need to avoid the rush for the sake of change in this most critical of policy areas.