Maternity options discussed for Parkes and Forbes hospitals

SUPPORT: Lots of happy smiling mums, bubs and midwives gather at Parkes Hospital to celebrate the International Day of the Midwife each year. Parkes midwives are still providing antenatal and postnatal support at the Parkes Maternity Unit. The unit is open for all services except birthing.
SUPPORT: Lots of happy smiling mums, bubs and midwives gather at Parkes Hospital to celebrate the International Day of the Midwife each year. Parkes midwives are still providing antenatal and postnatal support at the Parkes Maternity Unit. The unit is open for all services except birthing.

A midwifery-led model of care is one of the options being discussed during community consultations on the future of the Parkes maternity unit, but what does that mean for new mums?

As the health district plans future services in Parkes and Forbes, one option is to consider a midwife-led service at one location, with a maternity service supported by obstetricians and anaesthetists at the other.

Birthing services at Parkes came to a halt in June due to doctor shortages.

Director Rural Health Services Sharon McKay said the Midwifery Group Practice (MGP) model is quite common.

"Women electing to go into that model are risk assessed," she said.

"It's a very comprehensive process of history taking, monitoring your pregnancy closely with the midwives, and understanding where you fall in the risk stratification process.

"If you are deemed low risk - and that doesn't mean no risk - then you are eligible to continue in that model with a midwife and birth in a facility where there is no doctor on site."

Ms McKay said part of the operational processes and procedures of the midwife led model would outline very stringent guidelines.

"If something was to occur, there is a very prompt referral pathway," she said.

"For example, if you get to eight months pregnant and suddenly develop gestational diabetes then you are not eligible to stay in that program - we would refer you on to make sure you had the appropriate medical input."

Chief Executive of WNSWLHD Scott McLachlan said the vast majority of first world countries birthing models are nearly totally midwife led.

"Australia has had a medical model for a lot of years and I think that, now we are finding ourselves in the middle of this medical workforce crisis, it's actually time to stand back and ask what is the right thing for mums and bubs, what is the right thing for rural areas, and how do we make it safe," he said.

Ms Mckay said the health district hopes investing in midwives at Parkes sends a signal to the community that it is serious about making sure we have a safe birthing service.

"A review of the current midwifery staff skill base has highlighted additional courses they will be able to complete.

"I've just signed off on all our MGP Parkes midwives completing the Advanced Life Support in Obstetrics course," she said.

"Doctors and midwives learn skill base stations together and through that the midwife obtains advanced skills so they are able to do the same maneuvers and similar interventions - bar a caesar - to what a doctor can do.

"It's not a cheap course to undertake but we have committed to doing it."

Ms McKay said hopefully in the future the health district would be able to expand the commitment to include Forbes midwives but at the moment its focus is on the Parkes midwifery group.

"Midwives will also be learning to suture," she said.

"Most midwives do when they do their studies but when they work in a medical led model they tend not to get the opportunity and lose that skill."

The health district states that in Parkes and Forbes combined there were fewer than 280 babies born last financial year, in 2017/18 there were fewer than 60 caesareans performed and the closure of Parkes has had minimal impact on Forbes.

"One of our challenges with Parkes and Forbes is the proximity," she said.

"Many years ago, the combined numbers would have stopped us from getting a student midwife.

"They would have said there wasn't the volume of births to give someone the experience."

"We are doing everything, we are even growing our own midwives, we have student midwives at both sites but one hundred and something births each per year is another challenge in itself."

Ms McKay said staff shortages are not just affecting the medical workforce, midwives are in short supply as well.

"We have a few gaps at the moment and we are using agency midwives," she said.

"That's another signal that this isn't all about doctors, the gaps in midwives are just as real as the gaps in doctors."

Ms McKay said it's possible the midwifery led model of birthing might be more attractive when trying to recruit staff.

"Traditionally to be a midwife you would have been a registered nurse first and then you go into post graduate," she said.

"For the last five to 10 years there has been an increase in what they call direct entry midwifery qualifications, so you don't need to be a nurse first.

"It's a four year degree but it means you can't go and work in the emergency department if you are a midwife, your scope of practice wouldn't permit that."

Parkes midwives are still providing antenatal and postnatal support at the Parkes Maternity Unit and are able to attend the Forbes Hospital with the mums they are assigned to in the MGP Know Your Midwife program (KYM).

The unit is open for all services except birthing.