Maternity turf war: Medicos squabble as profession suffers, units shut

Insiders claim a turf war between doctors and midwives is behind the maternity recruitment crisis devastating parts of Queensland.

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Senior obstetricians and union representatives claim a turf war between midwives and regional doctors is to blame for a recruitment crisis crippling the state’s maternity services.

Queensland Health has also been forced to deny claims another regional maternity unit is about to go on bypass after a leaked email revealed fears Innisfail will be the next to fall amid ongoing issues at regional hospitals, including Gladstone, Biloela and Cooktown.

The same email, circulating among high-level obstetricians and seen by The Sunday Mail, claims junior doctors are avoiding entering the field because they can’t deal with how midwives treat doctors, there are clinical risks, and they don’t want to have to resuscitate neonates and do C-sections without second doctor backup.

And the Together Union says it has been involved in a case, that was reported to the health department, where doctors were reportedly locked out of a consultation with a pregnant woman.

Respected obstetrician and gynaecologist Ted Weaver is a past president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and has been a key investigator in several external obstetric reviews at state hospitals, including the Mackay Base review.

Obstetrician and gynaecologist Dr Ted Weaver.

He has chosen to speak out, saying while the best maternity care is delivered by a team, he believes changes in midwifery training over the years has made it more difficult for doctors and midwives to work collaboratively.

“Student midwives regularly tell stories of their lecturers openly bagging obstetricians and they often seem mistrustful of what we do – ‘too quick to intervene, too quick to over-medicalise pregnancy, too dismissive of a woman’s concerns’,” Dr Weaver said.

“Most midwifery care is fine and teams function well with no disharmony, but not all.

“There are some harmful ideologies out there.

“Similarly with obstetricians, most are fine but there are a few that are vehemently against any autonomous practice by midwives.

“There is definitely fault on each side which needs managing.

“It can be hard for junior medical staff, who can bear the brunt of bullying and poor behaviour from senior midwives.”

In the circulating leaked email seen by the Sunday Mail, the responses from trainees to doctors looking to recruit them into obstetrics included: “we see what you do, why would we do that”, “it’s too risky” and “I like obstetrics but my flatmate got so depressed after being bullied”.

The trainers were also said to claim “you are just the technician with no control over what presents to you in the birth suite now MGP run the show” – in reference to the Midwifery Group Practices, which offers women with less complicated pregnancies access to a primary midwife.

Queensland Health did not respond directly to questions about the escalating tensions among midwives and doctors.

There are fears the Innisfail Hospital maternity unit is about to go on bypass. Picture: Brendan Radke

The department said it could not respond “appropriately” without being provided a copy of the email and the names of people to be quoted prior to publication – a request that was denied by The Sunday Mail to protect its sources ahead of publication.

But in a statement, a spokesman said Queensland Health wanted to “assure Queenslanders of our ongoing commitment to provide safe and accessible maternity services, regardless of a birthing mother’s location”.

“The national workforce shortages in obstetrics and gynaecology – along with the maldistribution of these specialists – have made it extremely difficult to recruit and retain staff throughout Queensland, threatening the viability of maternity services in a number of regional and remote sites,” the spokesman said.

“We are exploring every possible solution to manage the delivery of neonatal, maternity, and gynaecological services in Queensland public hospitals where filling critical vacancies has been challenging.”

Dr Weaver said he believed conflict between doctors and midwives happened more in rural and regional units.

“From my observations of working in a regional area and having conducted clinical reviews in five regional rural hospitals, there can be a bit of ‘this is how we have always done this here’ when that way might be outmoded or unsafe,” he said.

“Regional staff do not have as many professional development opportunities as metro staff, and are wedded to ‘their way’ and don’t particularly like junior staff, coming in and suggesting new ways of working.

Dr Weaver said that junior medical staff are usually risk averse and may over-intervene, with good intentions.

“Some midwives hate that, and react accordingly,” he said.

Dr Sandy Donald is the Together Queensland union vice-president.

Together Queensland vice president Sandy Donald told The Sunday Mail that the union had not been consulted over “profound changes in the way doctors are expected to work”, even though consultation is mandatory.

“It has become clear over the past year or two that Queensland Health is changing the way maternity services are delivered,” he said.

“The Director General frequently talks about ‘strengthening midwifery’ but has not been clear about what this means.

“Both the Health Minister and the Director General have frequently talked about the shortage of doctors and difficulty recruiting.

“There has been almost no discussion of why so many doctors are quitting, especially those with training as a GP obstetrician (GPO).”

Dr Donald said over the past three years there had beenreports of a “hostile” environment in Cooktown, which has been on bypass for 12 months.

He blamed that conflict for the departure of some GPOs.

But more recently, he said there had been serious conflict between midwives and doctors due mainly to major changes to models of care introduced with MGPs.

“This has left midwives and GPOs with different and often incompatible approaches to care of pregnant women, making conflict inevitable,” he said.

“This included an incident where two doctors were physically prevented from entering a meeting.”

Torres and Cape Hospital and Health Service chief executive Beverley Hamerton.

Dr Donald said the union wrote an email about that incident to the chief executive and board chair of Torres and Cape Hospital and Health Service on December 7, 2022.

He said in a reply, the TCHHS acknowledged “a communication breakdown with interpersonal conflict”.

Dr Donald said that doctors report that problems continue.

Torres and Cape Hospital and Health Service chief executive Beverley Hamerton said staff at Cooktown worked collaboratively in what was often a “high-pressure and challenging environment”.

“It’s an employee’s personal decision to leave their employment and we are unable to comment on these choices,” she said.

“We have established process to manage and resolve any work-related issues between staff.

“We continue to recruit to vacant clinical positions, including for senior medical officers with advanced training in obstetrics and anaesthetics.”

The Together Union has also been called in to deal with reports of a deteriorating working environment in Innisfail.

“This once again involves MGP and a dramatic change in the role of the GPO — again without union consultation,” Dr Donald said.

“They report increasing conflict with some midwives who seem to believe the GPO should not have contact with pregnant women or any role in clinical assessment of risk.”

Despite the reports to the union and also in the leaked email, Queensland Health is adamant that at the Innisfail maternity unit there was “no need to go on bypass”.

Cairns and Hinterland Hospital and Health Service acting chief executive Jeremy Wellwood said that unit’s medical rosters were covered but recruiting was underway for one vacancy.

“We acknowledge that obstetric doctors are in short supply nationally and are therefore using a number of strategies to manage this vacancy,” he said.

Queensland Nurses and Midwives’ Union Beth Mohle said nurses and midwives should be enabled to work to the full potential of their roles.

“This includes Midwifery Group Practice or midwifery-led models of care, where midwives work with women throughout their pregnancies, during labour and beyond,” Ms Mohle said.

“Their expertise is invaluable and should be respected.

“With the current high demand on our health system across the country, there is more than enough work for all health workers to do right now.

“So our focus must be on working together and working collaboratively in new ways.”