Maternity services buckle in baby boom

Smaller Victorian hospitals try to take load from large institutions. By Linda Belardi

Victorian emergency departments are delivering an increasing number of babies due to a shortage of labour ward beds, according to an auditor-general's report.

The state's baby boom has placed significant pressure on maternity services leaving many women without access to appropriate services.

Maternity Coalition Victoria president Anne Catchlove said it was unacceptable situation. "It is completely unacceptable that women are birthing outside of the maternity [unit] in such a vulnerable and crucial time in the lives of women and their babies."

Catchlove said this would mean midwives would have to cross between different parts of the hospital in order to care for women.

Auditor-General Des Pearson reported that women in metropolitan growth areas were at risk of giving birth in non-admitted settings without a legitimate clinical reason.

In one of the audited hospitals singled out by Pearson, three women had birthed in the emergency department within the space of a week because of a shortage of beds.

Pearson said this placed women at clinical risk. "It also does not provide women and their families with adequate privacy and comfort. The high level of activity also increases the risk of staff 'burn-out', evident in interviews with staff at [one] health service," said the report tabled in State Parliament on October 11.

Pressure on maternity services has increased significantly, with the state experiencing a 16 per cent increase in the total number of births over the past decade.

In Melbourne's growth areas, one hospital identified by the report, experienced a 13 per cent increase in the number of births across a single year and that number is predicted to grow by a further 10 per cent in 2011.

Catchlove said the state's population boom had taken the departments by surprise and had not been adequately planned for by the health bureaucrats. "When the government rebuilt the new Royal Women's Hospital it was based on forecasts of population growth which have been far outstripped by what has actually taken place," she told Nursing Review.

She said the larger hospitals in Victoria have had to cap the number of women they accept in an attempt to manage demand. But in doing so, these management strategies have increased demand in local maternity units.

Women in metropolitan growth areas also faced increased costs and delays in accessing antenatal care, due to fewer publicly available services, the report said. In one region of Melbourne, women who are unable to access public antenatal care at their local service had to pay several thousand dollars for their care or often travel long distances to another health service.

Pearson said: "Women attending the hospitals we audited in metropolitan growth areas do not have equitable access to maternity services as there is a demand and supply mismatch. This is projected to increase with population growth."

However, he noted that the Victorian Department of Health is now improving its data collection on the timeliness of access to antenatal care to help improve services. Until very recently, the department had not undertaken an assessment of the capacity of health services to deliver maternity services.

Catchlove said the report also revealed the lack of options available for women to receive continuity of care. Despite recognising the value and preference of women for this model of care, less than half of women received continuity.

Demand for places in programs modelled on continuity of care far outweighed supply. "The report recognises how crucial this is for women and yet how few women are still able to access it in the public system. Only four of the 13 health services even offer this continuity model," she said.

"It is the common experience of women that they are not getting access to continuity of care. In one hospital, women were seeing on average 22 different care providers for their maternity care, birth and postnatally, and some women were seeing up to 32 care providers. This is something that we can also confirm as a significant issue from the experiences of women we talk to."

Catchlove said women who experienced continuity of care report high satisfaction and improved safety. "We also strongly support the recommendation for greater availability of information to women to make informed choices about maternity services."

On the same day the report was tabled in Parliament, the Victorian Health Minister, David Davis, announced the creation of a ministerial advisory committee on perinatal services from 2012. He said there was a clear need for better service planning, especially in Melbourne's growth areas.

Maternity services represent 5 per cent of all public hospital admissions in Victoria and 17 per cent of state-funded hospital outpatient appointments.

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