From continuity of care to homebirths: The search for better care in Bendigo's under-pressure maternity system

Bob Cameron and Fiona Faulks, of Bendigo Health, with Maree Edwards in the hospital's new maternity ward in 2016. The sector is being examined in detail by a parliamentary inquiry, with a range of issues becoming apparent.
Bob Cameron and Fiona Faulks, of Bendigo Health, with Maree Edwards in the hospital's new maternity ward in 2016. The sector is being examined in detail by a parliamentary inquiry, with a range of issues becoming apparent.

IN 1985, the caesarean rate in Victoria was 15 per cent.

Thirty years later, it had risen to 33.4 per cent – despite no overall physiological change in women. In private hospitals, the figure is as high as 43 per cent.

For the Midwife Collective – a group of three Castlemaine-based midwives carrying out home births – these figures reflect a broader problem in modern maternity care, something they believe has lost its focus on the wonder of childbirth.

One of the midwives, Sam Ward, said women were being “coerced” into believing there was only one way to deliver their child in the mainstream system.

“Standard maternity care has so many systems, standardised processes, checkpoints and flow charts that you can hardly see the woman anymore,” she said.

“It would not be uncommon for a woman to come into contact with over 50 different staff members during the course of her pregnancy care.

“Midwifery has always been about being with women, and always will be. Women in childbirth want women with them, preferably being nice to them, keeping a calm and watchful eye on them.”

The Midwife Collective help about 10 to 15 home births each year in Bendigo, Castlemaine, Daylesford, Heathcote and Kyneton.

Services of this type are becoming increasingly rare. There are only about 100 homebirth midwives in Australia – and just a handful in regional Victoria.

Another of the midwives, Elizabeth Murphy, said women needed to be provided more choices during their pregnancy.

“Some women don’t want to accept the standard care package that is provided to them during pregnancy, labour and birth,” she said.

At Bendigo Health, the Mamta program has provided continuity of care for pregnant women for the last 10 years. A team of two or three midwives care for the woman through their pregnancy, labour, birth and postnatally.

Each midwife takes on three women per month.

The program handles 250 births per year – of the 1300 babies born at Bendigo Health.

About 500 apply for the program, meaning half will miss out on guaranteed continuity of care with their midwives. 

They aim to have 60 per cent of the women in the Mamta program to be first-time births.

Bendigo Health Mamta co-ordinator Amanda Hewett said it was a “low risk model”, and it received far more applicants than it could provide care for.

“It’s a very popular program in the community,” she said.

“Our model’s been operating for 10 years now and we haven’t had an issue with recruitment or sustainability of the workforce.”

An increasing number of women from throughout the region are required to travel to Bendigo Health during their pregnancy if they are deemed “high risk”. 

This means they must undertake hours of travel from towns like Charlton, Swan Hill and even as far away as Deniliquin, where a growing number of pregnant women attending Bendigo Health are travelling from.

High risk could mean a high body mass index, gestational diabetes or the potential for various complications.

The Midwife Collective believe women should always have the option of giving birth in their local community – but smaller hospitals are not deemed capable of handling these pregnancies.

These are just some of the issues being considered by the state government’s inquiry into perinatal services in Victoria.

Another growing problem in the state’s maternity system – particularly in Bendigo – is providing adequate care for Indigenous women.

Raylana Harradine says Bendigo needs a Koori maternity service. Picture: NONI HYETT

Raylana Harradine says Bendigo needs a Koori maternity service. Picture: NONI HYETT

About 80 Indigenous babies are born in Bendigo each year.

But without a Koori maternity service in Bendigo, women must rely on the mainstream services offered by Bendigo Health.

Loddon-Mallee Aboriginal Reference Group chair Raylene Harradine said this presented a range of problems.

She said Indigenous people often viewed health services as “monolithic institutions” that were associated with intergenerational trauma.

“Often they represent a whole lot of complex things for Aboriginal people,” Ms Harradine said.

“The cultural awareness of the hospital is so important… so that they can get the wraparound services that are provided by Aboriginal community-controlled organisations.

“Koori maternity services provide an excellent model of care.”

Their request is simple – provide greater access to Indigenous-run services, and allow for greater self-determination in the services available.

Bendigo and District Aboriginal Co-operative health and wellbeing manager Christine Gibbins said ensuring these services were available at BDAC’s clinic would allow for better overall care of women.

She said a simple GP visit could reveal a range of other health and wellbeing concerns.

“There’s just a plethora of complex issues regarding Aboriginal health,” Ms Gibbins said.

BDAC hopes to form a collaborative agreement with Bendigo Health in relation to women’s health and pregnancy, and to review its memorandum of understanding with the City of Greater Bendigo around maternal health.