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The challenge is ours …
Improving safety and quality by
making maternity care better
for all women
Caroline Homer
6th Obst...
What is a ‘good’ maternity system?
• What is ‘good’ for you may not be good
for someone else
• What feels ‘safe’ to you mi...
My own story ….
How did we get to this?
Choosing outside the ‘system’?
• Lack of choices
• Lack of options
• Lack of respect
“Some women were abused because they ...
Strengths
“Australia is one of the safest places to give birth
or to be born” (Roxon, 2008)
•  Well educated workforce
•  ...
Weaknesses
“… current arrangements for the delivery of maternity
services in Australia are not serving all Australian
wome...
Opportunities
• Well informed consumers
• Well educated workforce
• Research showing the benefits of different
models of c...
Threats
• Lack of focus on maternal and newborn health
▫ More focus on acute care, emergency departments,
ageing
• Lack of...
Dreaming of better maternity care
AAAQ (triple AQ) framework
• Care must be:
▫ Accessible
▫ Available
▫ Acceptable
and of ….
▫ Quality
Source: State of the ...
Quality maternal and newborn care
Renfrew et al (2014). The Lancet, 383: doi:
10.1016/S0140-6736(14)60789-3
What does this mean in Australia?
• Elements of practice
▫  Support for normality – higher level care when needed
• Organi...
What can you do?
• Ensure the entire maternity system:
▫ includes respect, communication, community
knowledge and understa...
All women need continuity
Midwife-led care should the norm
for all women as part of a
functional consultation and
referral...
Enable spontaneous labour
Promote mobility during labour
Be with pain in labour
Have water immersion as a real option
Re-think the environment
Ensure one to one care in labour
Be flexible about supporters
Facilitate vaginal breech birth
Have options for place of birth
Enable women to choose homebirth
Promote and facilitate VBAC
Keep mothers and babies together
Have respectful collaboration
Recognise the role of the midwife
Explore why women and midwives
choose other options
•  Listen to women
o  Ask before telling
•  Be brave enough to hear
wh...
• We have the power to change the system
• Don’t wait for someone else – it is up to
us
▫ Midwives
▫ Obstetricians
▫ Polic...
Caroline Homer - WHO Collaborating Centre for Nursing, Midwifery & health Development University of Technology Australian ...
Caroline Homer - WHO Collaborating Centre for Nursing, Midwifery & health Development University of Technology Australian ...
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Caroline Homer - WHO Collaborating Centre for Nursing, Midwifery & health Development University of Technology Australian College of Midwives - The Challenge is Actually Ours – Improving Safety & Quality by Making Maternity Care Better for all Women

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Caroline Homer delivered the presentation at the 2014 Obstetric Malpractice Conference.

The Obstetric Malpractice Conference is only national conference for the prevention, management and defense of obstetric negligence claims.

For more information about the event, please visit: http://www.informa.com.au/obstetricmalpractice14

Published in: Health & Medicine
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Transcript of "Caroline Homer - WHO Collaborating Centre for Nursing, Midwifery & health Development University of Technology Australian College of Midwives - The Challenge is Actually Ours – Improving Safety & Quality by Making Maternity Care Better for all Women"

  1. 1. The challenge is ours … Improving safety and quality by making maternity care better for all women Caroline Homer 6th Obstetric Malpractice Conference 26 – 27 June 2014
  2. 2. What is a ‘good’ maternity system? • What is ‘good’ for you may not be good for someone else • What feels ‘safe’ to you might not be safe to someone else • Our willingness to accept ‘risk’ differs • Our own experiences shape our views
  3. 3. My own story ….
  4. 4. How did we get to this?
  5. 5. Choosing outside the ‘system’? • Lack of choices • Lack of options • Lack of respect “Some women were abused because they did or didn’t want a particular kind of pain relief during labour. Women were made fun of, or talked sternly to, like a naughty child, by midwives or obstetricians, when they were at their most vulnerable, naked and prone on a table. Women had their babies taken from them and placed in nurseries as a matter of course, the babies fed formula against the woman's wishes.” Source: Mary-Rose McColl, Birth Wars, 2009.
  6. 6. Strengths “Australia is one of the safest places to give birth or to be born” (Roxon, 2008) •  Well educated workforce •  Well informed consumers •  High quality facilities •  Modern technology •  Accessible (mostly) •  Innovators and researchers Source: Maternity Services Review, Commonwealth of Australia, 2008
  7. 7. Weaknesses “… current arrangements for the delivery of maternity services in Australia are not serving all Australian women as well as they should” (Roxon 2008) •  Limited models of care options •  High rates of intervention - fear •  Lack of respect for choice - fear •  Funding issues – rural women, women who choose homebirth •  Access issues – Aboriginal and Torres Strait Islander women, rural women, young women •  Professional turf wars Source: Maternity Services Review, Commonwealth of Australia, 2008
  8. 8. Opportunities • Well informed consumers • Well educated workforce • Research showing the benefits of different models of care ▫  Clinical outcomes ▫  Cost benefits • Positive policy environment – Towards Normal Birth (NSW) • New collaborative opportunities …..
  9. 9. Threats • Lack of focus on maternal and newborn health ▫ More focus on acute care, emergency departments, ageing • Lack of indemnity insurance solutions • Imploding turf wars ▫ Midwife vs obstetrician ▫ Midwife vs GP ▫ Clinicians vs lawyers ▫ Private midwife vs hospital midwife ▫ XXX vs XXX???
  10. 10. Dreaming of better maternity care
  11. 11. AAAQ (triple AQ) framework • Care must be: ▫ Accessible ▫ Available ▫ Acceptable and of …. ▫ Quality Source: State of the World’s Midwifery 2014. UNFPA, ICM, WHO
  12. 12. Quality maternal and newborn care Renfrew et al (2014). The Lancet, 383: doi: 10.1016/S0140-6736(14)60789-3
  13. 13. What does this mean in Australia? • Elements of practice ▫  Support for normality – higher level care when needed • Organisation of care ▫  AAAQ – continuity – community-based care ▫  Learn from errors • Values ▫  Respect – communication – care tailored to needs • Philosophy ▫  Using interventions only when necessary • Care providers ▫  Educated, supported, respected for unique skills ▫  Real collaboration
  14. 14. What can you do? • Ensure the entire maternity system: ▫ includes respect, communication, community knowledge and understanding, and care tailored to a woman’s circumstances and needs ▫ will optimise the normal biological, psychological, social, and cultural processes of childbirth, reducing the use of interventions to a minimum The Lancet Series on Midwifery 2014
  15. 15. All women need continuity Midwife-led care should the norm for all women as part of a functional consultation and referral network and effective collaboration
  16. 16. Enable spontaneous labour
  17. 17. Promote mobility during labour
  18. 18. Be with pain in labour
  19. 19. Have water immersion as a real option
  20. 20. Re-think the environment
  21. 21. Ensure one to one care in labour
  22. 22. Be flexible about supporters
  23. 23. Facilitate vaginal breech birth
  24. 24. Have options for place of birth
  25. 25. Enable women to choose homebirth
  26. 26. Promote and facilitate VBAC
  27. 27. Keep mothers and babies together
  28. 28. Have respectful collaboration
  29. 29. Recognise the role of the midwife
  30. 30. Explore why women and midwives choose other options •  Listen to women o  Ask before telling •  Be brave enough to hear why we failed – what we did or did not do o  Don’t put your head in the sand – it won’t all go away
  31. 31. • We have the power to change the system • Don’t wait for someone else – it is up to us ▫ Midwives ▫ Obstetricians ▫ Policy makers ▫ Lawyers ▫ Managers and many others ….. • We need to work with women to make maternity care better for all women
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