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A senior obstetrician says more than one in three women experience birth trauma in hospitals, and over-stretched rural health services can’t keep up.
Maria Luna Ramirez said she was often involved in debriefing women and families after traumatic events, and heard of birth choices being ignored and a lack of sensitivity from medical professionals.
The experience of the head of Lismore Hospital’s obstetrics and gynaecology department was contained among 4000 submissions that have overwhelmed those running a NSW parliamentary inquiry into birth trauma.
Having worked in Australia, Spain and developing countries for more than 20 years, Dr Ramirez said birth trauma affected a large proportion of women after having their babies in hospitals.
“Some of the statistics mention one in three, but I believe this to be underestimated as many women only realised how traumatising some events were many years later,” she said in her submission.
Dr Ramirez said parents were not getting proper support in stretched rural settings due to underpaid midwives and a reliance on temporary specialists.
“We are left to face the discontentment of the public on our own,” she said.
“Women (and) families are traumatised, and so are health workers.”
Lawyer and Human Rights in Childbirth chair Bashi Kumar Hazard told AAP the sheer number of submissions from across Australia to the birth trauma inquiry underlined the significance and prevalence of the issue.
“For every one complaint I have the resources to take up, I probably would let go another six,” she said.
“It’s quite systemic – it’s not intentional, but the system is designed to sort of override women’s wishes.”
More than a dozen submissions addressed care at Wollongong Hospital.
One mother recalled being denied an induction until 41 weeks, only for her spontaneous labour at 40 weeks to descend into a frantic emergency forceps delivery, significant blood loss and severe tears.
Midwives recalled a Third-World scene, while the woman’s husband was pushed out of the theatre crying and fearing his wife and baby might die, the mother said.
Another mother said she skipped check-up appointments because her wishes for a natural birth were repeatedly ignored.
The inquiry is expected to hear from a former clinical midwife at the hospital who is calling for formal birth debriefing.
“The (current) system is designed by middle-aged white men for throughput and expediency,” Fiona Reid said in her submission.
“The system does not respect women who decline treatment or … want it to be the most beautiful memory, not a memory or sense of being involved in a car accident.”
Western Sydney University academics behind the largest birth experience survey conducted in Australia said one in 10 women felt they had experienced some form of obstetric violence.
“Shockingly, some women described internal vaginal examinations in language used to describe sexual assaults,” the experts told the inquiry.
However, the term “obstetric violence” has faced opposition from the peak body for obstetricians, who say it wrongly implies intent to harm.
Consent remained the bedrock for improving women’s birthing experiences, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists said.
It said health-care providers had to have better and earlier discussions with patients about all possible outcomes during what was a high-risk period in the lives of women and their babies.
Dr Ramirez recommended a wider rollout of midwife group practice – often oversubscribed and restricted to low-risk pregnancies – and a focus on continuity of care.
Women enrolled in the program have regular appointments with a midwife and back-up midwives throughout pregnancy, labour, birth and the postnatal period.
NSW Health said workforce shortages and on-call requirements had limited its expansions of the practice, but alternative midwife-led models had been received well in regional settings.
It acknowledged women may experience both physical and psychological birth trauma in its hospitals, and said it committed to ensuring all women received respectful, evidence-based and equitable maternity care.
“The evidence around the prevention, identification and treatment of birth trauma is continually helping to shape policy and practice,” the department’s submission said.
The inquiry will hold its first public hearings next week.
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