Double standards?

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I was irritated to read this on the NASOG website. NASOG is the National Association of Specialist Obstetricians and Gynaecologists. My irritation lies in the fact that the obstetricians are concerned that with changes to the medicare safety net, the cost of private obstetric care will force it out of the price range of most families and that it will therefore cease to be a viable option (ie, fewer women will be able to access private obstetric care), yet the maternity reforms will have the same impact on midwifery care whereby access to midwifery care will be at the discretion of an obstetrician and fewer women will have access to private midwifery care. Many double standards exist in the article:

Australian women being denied the choice of a doctor during birth The current changes to private midwifery practice, requiring the midwife to have a signed collaborative agreement with an obstetrician (without the requirement of the obstetrician to sign such an agreement) will result in Australian women being denied the choice of a midwife during birth.

We believe every Australian woman should be entitled to choose a specialist obstetrician or GP. Likewise, every Australian woman should be entitled to choose a midwife. Around the world, midwives provide affordable, safe and effective care to women and families.

What choices do Australian women currently have? A woman can:  choose a private obstetrician or GP to deliver her baby in either a private or public hospital;  attend the public health system and be assigned to a midwives or doctors clinic, however, women cannot choose the doctor present at the birth, or  share care between a general practitioner and a public hospital antenatal clinic, however women cannot choose the doctor present at the birth.

Nowhere is the option of private midwifery care mentioned. The author of this article also fails to disclose that midwives attend the majority of births in the public system, not doctors. Within the public system, while women cannot choose the doctor who *might* be present at the birth, in some cases they will know the midwife who will attend them. Private midwifery practice, which delivers virtually 100% continuity of care - the midwife you book with is almost 100% likely to attend the birth - is not even mentioned in this part of the article. If continuity was the concern of the author, surely the model that delivers the greatest continuity would have been mentioned?

The article goes on to say: In fact doctors are not always present at births in the public hospital.

Shock Horror!! Births happen without a doctor's presence! Of course, we're not in there performing caesareans: obstetricians perform these operations. But hey, only about 15% women should need a caesarean; this rate is lower with private midwifery care. So for the vast majority, midwifery care is provided for the entire labour and birth. And the sky doesn't fall in.

The bottom line is you cannot choose care by an obstetrician in Australia, unless you can afford it. This is hardly supporting a fair choice for women.

Likewise, women cannot choose private midwifery care unless they can afford it AND unless the obstetrician has agreed. And this is hardly supporting a fair choice for women.

How much does private obstetric care now cost? The average out of pocket expense for women to have the care of an obstetrician is around $2,000. Private health insurance does NOT cover this amount. The Medicare safety net used to cover up to 80%, until the current Government placed significant caps on the amounts paid to women for Obstetric care in 2009.

How much does private midwifery care now cost? The average out of pocket expense for women to have the care of a private midwife is around $2,500 - $6,000 (depending on many factors). Private health insurance might cover some of this cost.

Collaboration is the buzz word of the day and it seems that the same issues affecting private midwives are also affecting private obstetricians. What if we lobbied the Government together to make private maternity care more affordable for more women? What if, together, private obstetricians and private midwives were able to attend every woman who was privately insured in a private hospital, private birth centre or private homebirth system? Maybe the pressure on the public health system would abate and women would have safer and more satisfying birth experiences with continuity of care.

Melissa Maimann, Essential Birth Consulting 0400 418 448