Melissa Maimann & Andrew Pesce: Collaborating for success

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ALTHOUGH only a handful of collaborative arrangements have been signed between obstetricians and midwives since national maternity reforms were introduced in November, calls for a policy rethink are premature and counterproductive.

In fact, the reforms provide an exciting opportunity for collaborative maternity care that is safe, locally responsive and woman-centred.

A variety of private maternity care models are possible and we are confident these will build on Australia’s strong record of safety and quality in maternity care. They will also meet the needs of women who want the familiarity and the comfort of knowing the obstetrician and midwife who will be with them through their pregnancy, birth and new parenting experience ...

Obstetricians may be concerned that the new arrangements mean they will not be directly involved in patient care until something goes wrong, while some midwives fear that the arrangements will be used to control midwifery practice, adversely impact on childbirth choices and promote anticompetitive restriction of trade.

We believe we are the first private obstetrician-midwife team in Australia to have successfully negotiated a formal collaborative arrangement and we are very happy with how it has progressed since our first discussions.

The first woman under our joint care gave birth in March this year and we have several others booked through to January 2012.

We share a similar philosophical approach to maternity care and have agreed practice guidelines that we believe to be safe, evidence-based and woman-centred ...

... Women appreciate the continuity of care, and the assurance that an obstetrician they have met will be involved if medical assistance is required. Feedback from women so far has been outstanding. The main criticism has been that this model of care is not available in other hospitals.

One of the reasons why there are currently so few collaborative arrangements has been the time taken by the Australian Health Practitioner Regulation Agency to endorse eligible midwives and by public maternity units to credential midwives in private practice.

... Our agreed guidelines are explained to patients before they engage our services and childbirth choices are not restricted. In fact, choices are enhanced as the midwife is able to attend births in the full capacity of a midwife in hospital.

Importantly, our model of care does not dictate “transfer” of care, merely a shift in the balance of obstetric and midwifery care because we recognise that every pregnant woman needs her own obstetrician and midwife. We support midwife care during waterbirth, vaginal birth after caesarean section, physiological birth positioning and physiological third stage.

Change is often difficult as we all tend to be creatures of habit. This change brings with it many opportunities for obstetricians and midwives in private practice to work together in ways that are beneficial to both and, importantly, to the women in their care.

... The maternity reforms will succeed if we remember that midwives and obstetricians are in it for the same reason — to provide safe care that meets the needs of our patients, within a respectful, professional environment.

Dr Andrew Pesce is an obstetrician practising in Sydney and immediate past president of the AMA. Ms Melissa Maimann is a midwife in private practice based in Sydney.