Birth changes are past their due date

At a time when fewer women are having babies, we should be doing all we can to make sure maternity care is as safe as possible. Instead, ideology is taking over.

A newborn receives care just minutes after birth. Picture: Getty Images

There is one culture war that truly is putting our next generation at risk more than any other. It is the ideological divide between the different groups that provide birth care in modern Australia. This has to stop and we have to ensure that the wellbeing of women and their babies truly is at the centre of our nation’s maternity systems.

At a time when Australian women are having fewer and fewer children – to the point where this “baby bust” is putting our country’s economic future at risk – we should be pulling out all the stops to ensure the safest possible arrival of our next generation.

Instead, pointless ideological conflict is confusing women and threatening the viability of one of the safest and most efficient parts of our health system. It is way past time that everyone involved in birth joined what we truly could call “team Australia”.

More than 15 years ago I published a study of close to 800,000 births that occurred across Australian hospitals. That analysis revealed that serious adverse outcomes both for babies and their mothers were much more common when specialist obstetricians were not directly involved in the birth.

The results were met with derision and abuse, despite it being one of the largest and most rigorous studies of its kind ever published. I was barred from ever having access to Australia’s birth outcomes database ever again. Social media campaigns against me burgeoned.

Now, a decade and a half later, another study that used more modern statistical methods of analysis has shown that things have actually worsened for women and babies.

Since the original research was published, the rate of death for babies has tripled from 0.3 per cent to 0.9 per cent, and the proportion of babies in poor condition at birth increased from 1.2 per cent to 3 per cent.

At a time when the outcomes delivered by our health system should be improving constantly, Australia’s mothers and babies are seeing potentially devastating outcomes becoming more common – just when birth is becoming so scarce that every baby is more precious than ever before.

The power of this new study is that it was driven from outside of the maternity system – by a tenacious and exacting economist in Professor Emily Callander. It took a women with no skin in the birth game to shine a light on the consequences of conflict and opacity that have characterised our national birth system.

The health of mothers and babies is too important to be left in the dark. Picture: Getty Images

The health of Australia’s babies and their mothers is too important to leave unstudied and shielded from view. It should be an article of faith that transparency is critical to healthcare.

The birth culture war needs to stop. Doctors could not manage birth without midwives – but the same is true the other way round. More than half of all births ultimately require the involvement of doctors.

The best birth care happens when each of the maternity carers – midwives and doctors – work together and play to their strengths.

Australian women must be given choice and their choices must be respected, certainly. Yet that choice must be informed, and outcomes of the different types of maternity care must not be hidden from women. That is true transparency and it should be available to every woman.

At the moment, the system that now has been shown not only to provide the lowest risk of adverse outcomes but also the most economical care is flailing. Australia’s private maternity system is at rock bottom, with the real prospect it will cease to exist by the end of the decade. That is staggering when considering what it has been shown to deliver.

Australia’s national maternity plan claims as its primary pillar that women should “receive individualised information and appropriate care during the perinatal period that is based on current, high-quality evidence”. Australian governments at all levels must put their money where their mouth is.

Pregnancy is inherently unpredictable, and with the best of intentions and preparation the course of a birth can veer off the rails with little warning, putting both mother and baby at risk. People like me whose lives are devoted to pregnancy and birth are at our best working as a team and putting babies and their mothers at the centre of everything we do.

For centuries, pregnancy and birth care were not subject to the same level of rigorous scientific study that other areas of medicine were. That, truly, was medical misogyny in its truest form. Thirty years ago maternity care took the wooden spoon for being the least guided by scientific evidence.

Things have turned around completely and we have pregnancy care to thank for ushering in the modern era of evidence-based care. So profound was this shift that maternity was used as the symbol of the leading evidence-led medical guidance group – the Cochrane Collaborative.

In our modern health system there should be no place for ideology – only evidence. Maternity carers are undoubtedly stronger together. The women they care for deserve to be given clear and unbiased guidance as to what the true strengths and outcomes are of the different types of care they can choose from.

One of the greatest obligations any health system has is to ensure that the next generation of babies have a safe arrival. When birth goes wrong, it can have lifelong consequences – sometimes severe. Now, more than ever, we need to listen to the evidence and let that guide us to a safe future.

Steve Robson is professor of obstetrics and gynaecology at the Australian National University and former president of the Australian Medical Association. He is a board member of the National Health and Medical Research Council and a co-author of research into outcomes of public and private maternity care.