The National Strategic Approach to Maternity Services (NSAMS) is currently being developed and lead by the Federal Government. The NSAMS will impact on maternity services now and into the future.
Safe Motherhood for All Inc. sits on the Advisory Group and we want to see change.
In Australia we are lucky enough to have one of the lowest pregnancy-related mortality rates in the world. However, despite this the maternal mortality rate is only a small fraction of the burden of maternal morbidity – the health problems borne by women during pregnancy, the postpartum period and for some for the rest of their lives. Current maternity care practices can and do lead to poorer health outcomes – as evidenced by a falling normal birth rate, the rising intervention rates, a rising birth injury rate; declining breastfeeding rates; rising postnatal depression rates; increasing reported birth trauma rates; and more recently with suicide during pregnancy and the postnatal period now one of the leading causes of maternal death in Australia.
What changes are we seeking? Our priorities are:
1. Endorse and implement the Respectful Maternity care Charter – The charter purposely focuses specifically on the patient’s experience of care – on the interpersonal aspects of care received by women seeking maternity services. Disrespectful maternity care represents a dimension of violence against women and it is imperative that the Australian community acknowledges, minimises and addresses the violence experienced by pregnant women. WHO states Governments should be working to: “Emphasize the rights of women to dignified, respectful health care throughout pregnancy and childbirth”
2. Stop treating childbearing as an illness – The current system intervenes too often in pregnancy and childbirth in ways that interfere with, instead of promoting, supporting and protecting, innate biological processes that result in healthier outcomes for women and newborns.
3. Collect the data to enhance accountability – Without the data we cannot truly understand the outcomes of maternity care nor have a credible understanding of the issues. An improved national maternity data set will inform future investments so as to maximise the return on investment, minimise wastage of limited financial resources, promote accountability, support a safety and quality framework for women and children and monitor the impact of changing models of care. At a minimum, we need to focus on:
a. Maternal morbidity. There is clearly a group of women, the numbers of whom are unknown, who continue to have short and long-term complications from their pregnancy and delivery.
b. Aggregated trended data can be deceptive and therefore not useful. As an initial focus, report all data by birth parity – first birth, second birth, third birth etc.
c. Report consistent, comprehensive data for maternal and perinatal mortality and morbidity by clinician, hospital and state/territory.
4. Provide access to Continuity of Midwifery Carer models of maternity care. The focus on maternity care is not just about the birth it is also about preparing for parenting. An increase in midwifery-led models of care reduces the rate of interventions, while keeping mothers and babies safe. Ultimately with Continuity of Midwifery Carer models women are satisfied with their care, their birth experience and have support in the post-partum period that enables to them to transition to parenting confidently. We would like all women have a consultation with a midwife in the first trimester of pregnancy.
5. Address the culture of fear – Health professionals need to remember that the woman is the expert on themselves and this must not be undermined by fear. The fear each woman has as she enters childbirth will have a direct relationship to the progress of labour. But whose fear is it really? Are women simply reflecting our fear? Is our fear impacting on our care? Is our care causing fear? Where relationships of trust are developed between women and midwives and models of care enable women to feel safe and powerful, fear can be reduced (Dahlen et al., 2010).
The government is now seeking stakeholder views on the design of NSAMS. The consultation template is available at https://consultations.health.gov.au/office-of-the-chief-nursing-and-midwifery-officer/national-strategic-approach-to-maternity-services/supporting_documents/NSAMS%20response%20template.pdf
The consultation closes on 18 June 2018.
We are very concerned that the consultation is missing those from low socio-economic populations, those with poor literacy, the CALD population and refugees. Without their input we will exacerbate the inequities already in the system.
We need the voices of women to inform the NSAMS. We need the voices of the community to be heard.
I encourage you to contribute to the consultation and to distribute the information about the consultation through your networks.
In anticipation, thank you