Anaesthetists have called for a rewrite of new draft maternity guidelines, arguing that they ignore their role in childbirth, are biased towards the use of midwives and could leave women vulnerable to complications.
The guidelines that are referred to are not legally-binding guidelines, but guidance for how collaboration between midwives and obstetricians could work. Midwives use the Australian College of Midwives’ Guidelines for Referral and Consultation which determine cases that we can look after autonomously and cases that we must refer on. Clearly, administering an epidural in outside the scope of a midwife’s practice, and so of course we would refer such cases to the relevant specialist, being an anaesthetist.
President of the Australian and New Zealand College of Anaesthetists Kate Leslie said the new draft guidelines underplayed the fact that at least 30 per cent of women having a baby opted for an epidural and at least 30 per cent had a caesarean section, which required anaesthesia.
That may well be the case in our obstetrically-led maternity services, however the guidance is for all midwives, including those in private practice and whose working in midwifery-led services such as birth centres. In such settings, epidural and caesarean rates are nowhere near the 30% rates that are quoted. Caesarean and epidural rates are around 5-10%.
The college is incensed that the latest draft National Health and Medical Research Council document - called National Guidance on Collaborative Maternity Care - mentioned anaesthetists just four times.
Professor Leslie said the document "showed overwhelming bias towards the role of the midwife with insufficient guidance on collaboration with anaesthetists". She said it also favoured midwives over anaesthetists.
There is no overwhelming bias towards the role of the midwife: the midwife is involved in every single birth that takes place in this country, whether pubic, private, operating theatre, delivery suite, birth centre or home. Midwives play a key role in each and every birth, unlike obstetricians and anaesthetists whose expertise is needed in a minority of cases.
"A claim that midwives can provide all aspects of routine pregnancy, labour and birth and postnatal care is misleading," Professor Leslie said.
It’s actually an accurate claim: we do provide all routine care. We refer on to obstetricians and anaesthetists for care that is non-routine. In this way, we provide a safe and responsible level of care to pregnant and birthing women.
… She said anaesthetists played a crucial role in the antenatal assessment and planning of women with complex medical and obstetric problems and in resuscitating women.
Complex medical and obstetric problems are not managed by the midwife autonomously. They are co-managed by a midwife and obstetrician, and in some cases, they are managed solely by an obstetrician. If the anaesthetists are of the opinion that their role is not respected, they may need to speak with obstetricians who are the ones to manage women with complex medical and obstetric conditions.