Mother-baby healthcare in need of urgent overhaul

While all political parties have shied away from difficult challenges throughout the election campaign, Australia’s broken maternity health system is too serious a crisis to ignore. While the system is fundamentally safe, women, their babies and healthcare professionals deserve better than the ramshackle mess that is undermining choices for women in delivery options. In some cases it is even costing lives and putting babies’ lives at risk. In a series of articles since Saturday, health editor Natasha Robinson has exposed a shocking reality Australians would not expect here. That is, giving birth in a public hospital is significantly riskier for women and their babies than being under the continuous care of an obstetrician in a private hospital. Most public hospital maternity care entails patients seeing different midwives at each check-up, and often not knowing the midwife who delivers their baby, with obstetricians called in cases of emergency.

The nation’s largest database of births, including 350,000 births across NSW, Victoria and Queensland from 2016 to 2019, tells a shameful story. Baby deaths were 53 per cent higher, stillbirths 56 per cent higher and deaths soon after birth 48 per cent higher for those in multi-professional public care compared with obstetric-led continuity in private care. Upcoming research by Monash University professors Emily Callander and Helena Teede reveals almost 200 excess neonatal deaths occur each year in public ­hospitals compared with private hospitals across the three states. And about 700 more babies are born with a low Apgar score, which measures how well bubs are breathing and is an early measure of health. The data looks at similar groups of ­mothers, adjusting for factors such as high-risk patients and socio-economic status.

The problems are not only about cost. As Robinson wrote, the shutdown of private birthing units will cost taxpayers an extra $1bn a year unless an urgent fix is found. Births are cheaper in the private system, where insurers subsidise care, patients foot out-of-pocket costs, and interventions are planned to help avoid complications such as major haemorrhages or baby resuscitation. Litigation over catastrophes in public hospitals is on the rise. A major part of the problem is that 18 birth units have closed in private hospitals over the past seven years, including 10 in the past three to four years, as patients baulk at out-of-pocket costs. Nor does bureaucratic bloody-mindedness help.

Cairns Base Hospital has barred private obstetricians from delivering babies on its premises, despite a marked rise in peri-natal deaths. In Darwin, the imminent closure of private maternity services has prompted mothers who have experienced public and private care to consider travelling interstate for future deliveries. Forcing women to consider such options is unacceptable in a First World health system. So is the erosion of choice. While public hospital midwives tend to favour noninterventionist care, some mothers find, to their dismay, that they are unable to ensure an anaesthetist is available to give an epidural at the optimum time.

It is high time to heal part of the health system that is riven by unhelpful cultural and ideological divisions, as ANU professor of obstetrics and gynaecology Steve Robson wrote on Saturday. Former health minister Greg Hunt, now an Honorary Melbourne Enterprise Professor at the University of Melbourne, says Queensland’s peri-natal death rate of more than 1 per cent is a “jaw-dropper’’. He has put forward a five-point plan to address the crisis, including national laws on maternity and birth, changes to private insurance, and access for private patients to public hospital birth units if there are no private facilities within 25km. It is a useful start for overhauling a key section of the health system that is about new life and the future. Patients deserve informed choices and care that is second to none. Anthony Albanese, Peter Dutton and frontbenchers running for office must address the issue.