Mothers and babies sent home too soon, says senior obstetrician
There’s a national crisis in private maternity care, but that’s just the beginning of the problem for our dual-model hospital system. Right now, the health of women and children deserves all our attention, but the cracks in the entire structure are widening.
Darwin
Sydney
Brisbane
Perth
Cairns
Geelong
Bunbury
Gosford
These are just some of the private maternity services that have closed in Australia in the past two years. It is a crisis in women’s and children’s health that demands national attention.
The closure of Healthscope’s private maternity services in Darwin and Hobart was just the latest example of the existential threat to private obstetric care. While it preceded the broader financial collapse of Australia’s second-largest private hospital group, that just served to further demonstrate that obstetrics is the “canary in the coalmine” when it comes to the success and failure of both the private hospital industry and private health insurance.
I am fortunate to be in active practice in a very well-resourced hospital in Perth which is almost unique in the calibre of its services, not only its obstetric care and the fabulous group of midwives I am so proud to call my colleagues, but 24/7 subspecialist neonatal pediatric cover, 24/7 anaesthetic cover, and a whole variety of other ancillary services including an intensive care unit, interventional radiological capability, and a blood bank.
Regrettably, St John of God Healthcare recently made the decision to excerpt the planned new maternity and neonatal wards from its exciting redevelopment in Subiaco. Other private providers are stepping away from maternity care altogether. Other groups long ago realised the margins are too tight to invest. It is yet another example of the gender gap in our health system. The bundled payments for a birth are nowhere near as attractive as those for orthopaedics and neurosurgery.
The presence of an intensive care unit on site surgical, psychiatric and radiology capability are not the things that sell a private birth to prospective parents. This is not a sales pitch for private obstetric care. Similar services are available in large public obstetric units around Australia. But the diminution in private hospital capability is a problem for the whole system.
Firstly, there is no capacity capability in the public maternity system to pick up the slack. Like the rest of the public hospital system, it is creaking. There is huge pressure on busy labour wards. Post-natal lengths of stay less than 36 hours are regarded as routine practice. Women and their babies are being discharged too early without sufficient support.
Our geography, with big cities and a mobile workforce, means family supports can live hours away. The perinatal mortality rate remains determinedly stable despite advances in quality metrics in most other areas of healthcare. Recruitment and retention of midwives, nurses, doctors and other staff is a daily challenge.
The system simply cannot accommodate even a small slice of the 100,000 births that currently occur in private hospitals.
Secondly, Australian families deserve a choice. Couples with private health insurance are entitled to choose not to birth in a private hospital. Couples living in the outer suburbs or the regions should be able to make an informed choice between the higher level of service that might be on offer in the city or the reduced disruption to family life implicit in delivering closer to home. Competition between the public and private system drives quality.
Thirdly, regular readers of The Australian and this section will have read a number of articles about the different outcomes seen between public and private maternity services, among opinion pieces written by my colleague Professor Steve Robson, informed by his long and distinguished career in public and private obstetrics. The private system has driven better outcomes and is one of the reasons that maternal and perinatal mortality rates are lower in Australia than comparable countries such as New Zealand and Britain, where private obstetric care is less freely available.
Morally, governments have no choice but to act to reform the private health insurance settings that now discriminate against women and young families. Not-for-profit hospital providers and not-for-profit mutual private health insurance providers still need to keep their heads above water. Listed hospital and PHI entities have a fiduciary duty to deliver shareholder returns.
It is seven years since I sat on the Private Health Ministerial Advisory Committee convened by then federal health minister Greg Hunt and chaired by Dr Jeffrey Harmer AO. Things have not improved.
As a community, we should be demanding a change in the settings that make hip replacements in people in their late 80s affordable, but young families starting out in life left with no choice.
We have known for a generation about the developmental origins of adult disease. Taking care of pregnant women during their pregnancy and in the months after their delivery is an investment in preventive health. The canary is singing. We must act collectively before it is too late.
Dr Michael Gannon is a consultant obstetrician and gynaecologist with 18 years’ experience as a specialist. He has delivered over 5000 babies. He served as president of the AMA from 2016 to 2018. He is president of leading professional indemnity provider MDA National.
This column is published for information purposes only. It is not intended to be used as medical advice and should not be relied on as a substitute for independent professional advice about your personal health or a medical condition from your doctor or other qualified health professional. More Coverage
Hobart