Dear subscribers,
Posted on the midwifery-research
UK was the following to the news of the John Hunter.
cut and pasted with love nigel.
Date: Tue, 24 Aug 1999 12:15:54 +0100 (GMT Daylight Time)
Subject: Re: John Hunter Team Midwifery axed
From: Chris mcCourt <[log in to unmask]> | Block address
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Dear Australian subscribers,
Clearly, more good quality research evidence on the economics of models
of midwifery care is needed. The Centre for Midwifery Practice in the
UK undertook a very detailed economic evaluation of the pilot scheme
for caseload midwifery - One-to-One midwifery practice. the evaluation
was led by James Piercy, a health economist from York Health Economics
consortium. A report is available from YHEC at York Univeristy, England
which gives full details of the analysis. A more summarised account is
available in the evaluation report on One-to-One Midwifery. for more
details see the University website at www.tvu.ac.uk
However, I have to say that despite a lot of hard work and valiant
efforts on the part of researchers to get thorough and good quality
data in a situation where routine economic recording is poor and
selective, and conduct of the evaluation by a highly regarded
independent research unit, the economic findings were largely ignored
by service providers, who prefer to work to their own system of
budgeting. It may seem commonsense that midwives with caseloads of 40
women (births) per year is surely a luxury but it is not necessarily
correct. All relevant costs must be counted as far as possible. The
analysis found that caseload midwifery was not more expensive than
conventional care. This may be explained by greater potential
efficiency of such a model compared to an institutional production line
one - such models were, after all, dropped by the automobile industry
long ago.
The one-to-one scheme was also threatened with closure, and
continuing uncertainty and delaying of decisions about the future have
increased stress for the midwives, who remain, as far as I am aware, on
temporary contracts for these posts and perceive themselves to be
unsupported within their employing Trust. This situation has encouraged
a large number to leave their jobs. It was not closed due to vocal
opposition by local women and the midwives themselves, but appears to
remain in 'limbo'. Good Catholics among us will known that is an
uncomfortable state to be in.
You might like to check out a short commentary which I wrote in MIDIRS
last year on this issue: McCourt C. Update on the Future of One-to-One
Midwifery.
MIDIRS Midwifery digest 1998;8(1):7-10.
wow!
--- Chris mcCourt <[log in to unmask]> wrote:
> Dear Australian subscribers,
>
> Clearly, more good quality research evidence on the
> economics of models
> of midwifery care is needed. The Centre for
> Midwifery Practice in the
> UK undertook a very detailed economic evaluation of
> the pilot scheme
> for caseload midwifery - One-to-One midwifery
> practice. the evaluation
> was led by James Piercy, a health economist from
> York Health Economics
> consortium. A report is available from YHEC at York
> Univeristy, England
> which gives full details of the analysis. A more
> summarised account is
> available in the evaluation report on One-to-One
> Midwifery. for more
> details see the University website at www.tvu.ac.uk
> However, I have to say that despite a lot of hard
> work and valiant
> efforts on the part of researchers to get thorough
> and good quality
> data in a situation where routine economic recording
> is poor and
> selective, and conduct of the evaluation by a highly
> regarded
> independent research unit, the economic findings
> were largely ignored
> by service providers, who prefer to work to their
> own system of
> budgeting. It may seem commonsense that midwives
> with caseloads of 40
> women (births) per year is surely a luxury but it is
> not necessarily
> correct. All relevant costs must be counted as far
> as possible. The
> analysis found that caseload midwifery was not more
> expensive than
> conventional care. This may be explained by greater
> potential
> efficiency of such a model compared to an
> institutional production line
> one - such models were, after all, dropped by the
> automobile industry
> long ago.
>
> The one-to-one scheme was also threatened with
> closure, and
> continuing uncertainty and delaying of decisions
> about the future have
> increased stress for the midwives, who remain, as
> far as I am aware, on
> temporary contracts for these posts and perceive
> themselves to be
> unsupported within their employing Trust. This
> situation has encouraged
> a large number to leave their jobs. It was not
> closed due to vocal
> opposition by local women and the midwives
> themselves, but appears to
> remain in 'limbo'. Good Catholics among us will
> known that is an
> uncomfortable state to be in.
>
> You might like to check out a short commentary which
> I wrote in MIDIRS
> last year on this issue: McCourt C. Update on the
> Future of One-to-One Midwifery.
> MIDIRS Midwifery digest 1998;8(1):7-10.
>
>
>
> On Thu, 12 Aug 1999 10:13:37 +1000 Sally Tracy
> <[log in to unmask]>
> wrote:
> > The flagship of Australian midwifery continuity
> of care is sunk!
> > Dear colleagues
> >
> > The decision THIS MORNING to axe the Team
> Midwifery programme at John
> > Hunter is firstly tragic and secondly demonstrates
> a blatant disregard
> > for numerous State and National Maternity Service
> recommendations that
> > encourage the provision of continuity of care
> models.
> > ref:
> > Rowley, M, Hensley, M, Brinsmead, M, & Wlodarczyk,
> J. (1995). Continuity
> > of care by a midwife team versus routine care
> during pregnancy and
> > birth: a randomised trial. Med J Aust 163(9),
> 289-293.
> >
> > Press Release from the NSW Midwives Association
> >
> > Team Midwifery Programme axed at John Hunter
> Hospital
> >
> > All about dollars and not sense!!!
> >
> >
> >
> > The NSW Midwives Association is extremely
> concerned over the proposed
> > abandoning of the Team Midwifery Programme at John
> Hunter Hospital. This
> > programme was established in 1991 when the
> hospital first opened. It is
> > comprised of a team of 5.6 midwives who care for
> around 280 women a
> > year.
> >
> > The team provides continuous care for women and
> their families
> > antenatally and during labour. Postnatal
> debriefing and support is also
> > available up until six weeks after the birth.
> Thousands of women have
> > experienced the satisfaction of knowing their
> midwife during the
> > antenatal period and at their birth. This
> programme has been a
> > forerunner for over thirty such continuity of care
> programmes
> > established Nationally. John Hunter has gained
> both national and
> > international recognition for this innovative
> service through the
> > publication of research into the programme in the
> Australian Medical
> > Journal, 1995. The research showed this care led
> to lower rates of
> > intervention and greater satisfaction for women
> when compared to
> > mainstream care. The establishment of the Team
> Midwifery Consumer
> > Participation Group reinforces the commitment
> childbearing women have to
> > this model of care. To abandon a programme that
> has met the needs of so
> > many women so superbly would indeed be a
> retrograde step for
> > childbearing women and their families in this
> country.
> >
> > Recommendations from: the Shearman Report 1989/90;
> the NHMRC Options for
> > Effective Care in Childbirth, 1996; the NSW
> Maternity Advisory
> > Committee, 1997; NHMRC Review of Services Offered
> by Midwives, 1998; and
> > the NSW Framework for Maternity Services (DRAFT),
> 1999, urge
> > implementation of more continuity of care
> programmes for women and
> > facilitation of many different models and options
> of maternity care. All
> > these reports have indicated that women are
> requesting flexible models
> > of care, continuity of care, shorter antenatal
> clinic waiting times, and
> > more consistent advice. The John Hunter Team
> Midwifery programme met
> > these needs for years.
> >
> > The decision to abandon the Team Midwifery
> Programme at John Hunter is
> > simply about dollars and not sense. The Obstetrics
> and Gynaecology
> > Division has a budgetary shortfall and the 5.6
> midwives that staff the
> > Team Midwifery Programme are the sacrificial
> lambs. It is far easier to
> > find and dispose of a complete model of care that
> would reduce the
> > Division’s financial shortfall than to examine and
> control the many
> > costly practices and procedures not based on
> evidence. Midwives will not
> > allow their services to be sacrificed when so much
> evidence supports
> > their care. It is childbearing women and their
> families that will be the
> > ultimate losers in this game of money and
> politics.
> >
> >
> > Letters have been sent to the following people
> from the NSW Midwives
> > Association expressing our concerns and asking for
> the matter to be
> > reconsidered :
> >
> > Dr Katherine McGrath
> > Chief Executive Officer
> > Hunter Area Health Service
> > Locked Bag 1
> > Hunter Region Mail Centre
>
=== message truncated ===
===
>From Cathy Bock and Nigel Duncan.
at
BIRTHING HANDS (Homebirth, ante/post natal care and hospital support)
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0414 886827 or 0414 554840
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