The NSW Minister for Health The Hon John Hatzistergos Supports Belmont and Ryde Publicly
The NSW Minister for Health, The Hon John Hatzistergos gave his public support in Parliament to the midwifery led units of Belmont and Ryde. He was asked in Parliament, in May this year, by the Hon Jan Burnswoods about the progress of the midwifery-led units at Belmont and Ryde hospitals. It is wonderful to have a Minister for Health who has weighed up the evidence, listened to the counsel of balanced professionals (both midwives and doctors) and heard the strongly articulated needs of the community. The NSW Midwives Association commend him for his support and persistence over this issue.
Read for yourself what he said in the NSW Legislative Council Hansard (4 May 2006).

The Hon. JAN BURNSWOODS: My question without notice is addressed to the Minister for Health. Would the Minister inform the House on the progress of the midwifery-led units at Belmont and Ryde hospitals?

The Hon. JOHN HATZISTERGOS: Comprehensive evaluations have been completed recently of the midwifery-led services at Belmont and Ryde hospitals. I am pleased to inform the House that both reports express positive remarks confirming that mothers and babies using the services have had excellent outcomes. Both hospitals operate stand-alone midwifery-led units under the strictures of clinical guidelines. Only low-risk women are accepted into the programs, and these women are screened extensively throughout their pregnancies for any problems. Should any risk or complications develop at any time, the woman is immediately transferred to Royal North Shore Hospital in the case of Ryde Hospital and to John Hunter Hospital in the case of Belmont Hospital.

It is important to emphasise that both services commenced after extensive consultation with the community, midwives and doctors. During the first seven months of service the Belmont Birthing Service cared for 108 women and their babies. Of the 52 women who eventually gave birth at John Hunter Hospital, only 5.5 per cent had caesarean sections compared to 26.6 per cent across New South Wales. This is a good outcome in itself. The report notes that patient satisfaction was extremely high even when births took place at John Hunter Hospital.

With regard to Ryde, the first evaluation of the safety and effectiveness of the caseload midwifery care within the Ryde Midwifery Group Practice is based on the 245 women who used the service. Again, all the women and their babies are well. The quality audit supports the fact that having a known midwife before pregnancy, birth and the post-natal period enhances the experiences of the women involved. I congratulate the midwives, local clinicians and obstetricians who contributed to the successful operation of Belmont and Ryde. In view of their success the Opposition should be ashamed that it has not publicly supported them and the women who use these services.

Indeed, the member for North Shore and the Hon. Robyn Parker, in their joint press release of 22 September 2005, asked me to rule out the use of maternity services of this nature. In March of this year Ms Skinner put out another press release expressing concerns about midwifery-led units. I hope that these results at Ryde and Belmont will encourage the Opposition to finally give this type of midwifery-based care its full support. The community is demanding more of these services, and I am pleased to inform the House that last Friday, 28 April, I officially launched the Camden Midwifery Group Practice, which offers continuity of care with a dedicated midwife through all stages of pregnancy.

I had the opportunity to meet Georgia, the first baby born through the new practice, and her mother. Also, 150 women have booked to use the service and it is now fully booked until October this year. I am impressed with the broad level of support displayed for the new service. Instead of supporting the Camden Midwifery Group Practice, the member for Vaucluse has made completely unrealistic promises to introduce an obstetric-based service at Camden Hospital. The Opposition has not grasped the significant challenges that face New South Wales, particularly the obstetrics work force. It is not as easy as it is claimed to set up a fully staffed obstetrics service at Camden. The Camden community understand this. This is why the Macarthur Chronicle dismissed the promise of the member for Vaucluse as a "political stunt" and "a crisis in the waiting". The editor went on to write:

If there is a shortage of specialists in maternity across the world, how will they entice them to Camden when other previous attempts were so unsuccessful?

Why waste more money on opening a unit that proved to be unsustainable?

They are good questions and the Opposition needs to answer them. In contrast to the Opposition, which seems determined to play politics with maternity services, the Government supports the provision of safe, sustainable choices for women and their families.

________________________________________Proof, NSW Legislative Council Hansard, 4 May 2006, Pages 21 - (article 29)

Mother's trauma as hospital shuts its doors to births
Julie Robotham Medical Editor
February 13, 2007
EMMA NATHAN wept when she was told she would not be allowed to give birth at Ryde Hospital, the flagship of the state's midwife-led birth program.
"My choice was taken away. I chose Ryde because there were no doctors and we couldn't afford a homebirth midwife," said Ms Nathan, who wanted a natural birth for her third child after the traumatic arrival of her second, in which her wishes were overridden by obstetrics staff at a private hospital. Women have not been able to have their babies at Ryde since November when health service officials said they could not find a doctor with resuscitation skills to provide back-up in an emergency.
Instead, women cared for by the Ryde midwives must go to Royal North Shore Hospital, though they may return to Ryde for postnatal care. To ensure her son, Joshua, now three weeks old, was born without unwelcome medical intervention Ms Nathan, 32, stayed at home as long as possible during her labour. "I was only at hospital one hour before I had the baby," she said. "I was there for four hours [afterwards] and then I came home."
Midwives and consumer groups say the decision to shut Ryde for births, which officials say is temporary, highlights anomalies in safety rules that insist a doctor be on call to cover the service.
Hannah Dahlen, secretary of the NSW Midwives Association, said: "One thing we never want to do is suggest we don't need doctors." Women at risk of complications were transferred to doctors' care earlier in pregnancy or labour and highly qualified midwives undertook the same resuscitation training as doctors.
An audit last year of the Ryde program's first year found one-third of women who joined the program were transferred to a larger hospital because they needed more complex care. All 179 babies born at Ryde were healthy, and the births progressed without any serious difficulties.
Justine Caines, from the advocacy group Maternity Coalition, said birth services should be better planned and resourced, so they did not collapse over the lack of a single staff member. "How can we be running maternity services on the benevolence of individuals?" she said. "That doesn't give us safety and quality."
In a statement to the Herald, a spokeswoman for Northern Sydney Central Coast Health said staff had been appointed and deliveries were expected to resume at Ryde next month.
Michael Nicholl, the clinical director of women's, children's and family health for the North Shore and Ryde, said although emergencies were unlikely in the Ryde program, "labour and delivery can still be unpredictable … It's our responsibility to be prepared and have medical expertise available".

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Midwives doing it tough in Country NSW
Friday, 6 May 2005
Presenter: Samantha Leary
Thursday the 5th of May was International Midwives Day...A time to stop and recognise the role played by midwives throughout the state...And today we find out how they're doing it tough in country areas...
It seems particularly timely that just a few days off from Mothers Day…we stop to remember the role midwives play in helping women become mothers themselves…

On this International Day of Midwifery…we also stop to consider the claim that around a third of all registered midwives are refusing to practice their profession because of unfavourable conditions…

But their services have never been in higher demand, particularly in country areas, where many rural birthing units are closing, forcing some women to give birth on the street or on the side of the road…as was the case recently in Nevertire…

So with the Rural Doctor’s Association calling on the state government to improve the availability of obstetric services in the bush…

What pressure is this situation placing on rural midwives who are being forced to pick up the slack?

Dr Barbara Vernon is the Executive Officer of the Australian College of Midwives, she says there is a national shortage of midwives, particularly in country areas.

She says a lot of midwives who work in the country are increasingly frustrated at not being able to perform the task for which they have been trained. Instead of being able to work alongside pregnant women and help them through their pregnancy they're being forced to take on other nursing roles in the hospital because of the lack of trained nursing staff.

"Midwives are much more satisfied in their jobs when they're given the chance to build relationships with other women, which is exactly what they have been trained for"

She also says midwives in rural areas are also forced to perform tasks that aren't in their job description because there just isn't anyone else. Funding for midwife positions comes under the Federal government umbrella so the State Government is reluctant to step in.

"Many midwives are also highly capable health professionals who don't need to be supervised by a doctor and they all follow national guidelines...yet many are not given the recognition they deserve and this leads to far-reaching job dissatisfaction."

Dr Vernon says another factor is that insurance is also not available to women who want to practice independently, forcing them to work in the health system...
So many are forced into providing care in a fragmented way and aren't able to build proper relationships with the women.

She says all of the workforce problems in midwifery could be solved in the next three years if the training opportunities were available...unfortunately the funding just isn't there.

She hopes that on this International Day of Midwifery, more people will acknowledge the crucial role played by midwives across country NSW and throughout the state...