Maternal mortality in Australia – 30% under-reported?
Maternal deaths in Australia compared with England and Wales from 1967 to 1969
The MMR for Aboriginal and Torres Strait Islander women remains three times higher than the MMR for non-Indigenous women.
Monitoring maternal mortality and morbidity in Australia
We need first to ask, how good are the data? There is a concern about under-ascertainment. As distinct from a stillbirth or a neonatal death, there is no mandatory notification of maternal mortality, although some States and Territories have a ‘tick box’ for notification that the deceased has been pregnant within the preceding 12 months. It is generally held that in the absence of coordinated efforts to maximise ascertainment, maternal deaths are underestimated by as much as 30 per cent. Some States undertake such efforts, but as is so often the case in public health surveys in Australia, there is variation between States and Territories in the approach to ascertainment. Failure to notify might be more likely for deaths in early pregnancy and when the death occurs remotely in time and/or place from the birth or termination of the pregnancy.
There is also variation and inconsistency in the way in which maternal mortality committees function in Australia, with respect to consideration, classification and reporting of maternal deaths. For example, in the compilation of the most recent report on maternal deaths in Australia, it appeared that there was no functioning maternal mortality committee in Queensland, which was the State with the highest MMR in Australia (over the previous twelve years).Only some States consider and report on preventability. Other States refrain because of privacy or other concerns. There are also variations in referrals of these deaths for coronial investigation. From 2003 to 2005, only 47 of 65 deaths were reported to the coroner, and only 19 of the 29 direct deaths were referred to the coroner.
There are also concerns about the quality of data indicating Indigenous status. In the 2003 to 2005 report, data on Indigenous status was missing in eight per cent of maternal deaths. This deficiency is of special importance because the MMR for Indigenous women was 21.5, compared with 7.9 per 100,000 for non-Indigenous women, reflecting their health disadvantage, in pregnancy and childbirth, as it is in all areas of health of Indigenous
groups.
It is estimated that for every maternal death, there are approximately 80 instances of severe maternal morbidity, in which the woman experiences a life-threatening complication from which she survives (completely, or sometimes with residual injury).
A concerning aspect of maternal mortality monitoring in Australia is the lack of recurrent funding or a permanent auspicing agency. The last national maternal mortality report carried a foreword signed by the Director of the Australian Institute of Health and Welfare (AIHW), which auspiced and authorised the report that contained this statement:
‘..the (Australian) Commission (on Safety and Quality in Health Care)
is not able to provide ongoing funding (for regular reporting of
maternal deaths in Australia) and it is concerning that no resources
have been identified to sustain and improve this reporting in the future.’An options paper to obtain a firm footing for the national maternal mortality survey has been prepared by the AIHW and submitted to the Commission on Safety and Quality in Health Care, but no response had been received at the time of preparing this article.
Maternal mortality in Australia 1964-72
Maternal mortality in Australia, 1973–1996
Maternal deaths in Australia 1997-1999
Maternal deaths in Australia 2003-2005
Maternal mortality in Australia – 30% under-reported?
Tags: birth in Australia, birth trauma, maternal mortality
Filed under: consumers' rights, reproductive justice
Press cuttings
Updated list-in-progress here.
Shamed but not named: bad medics use law to hide their identities
Paying for negligence: Birth bungles cost $115m in NSW alone
Hypervirulent strain of Clostridium difficile in Epworth Hospital in Richmond Melbourne
Scared nurses’ secret evidence of intimidation
No room at the hospital for sick toddler
Hospital blunder turns into family heartache
Obstetric and gynaecology claims
Two baby deaths as a result of ventouse use by the same obstetrician
Hospital workers’ hands off attitude to hygiene
Newborn baby dies after ventouse
Patients are people, not guinea pigs
HIV, hepatitis fears after failings in hygiene care at clinic
Male doctors to get chaperones after sexual misconduct claims
Jayant Patel kept negligence a secret: court
Blaze forces maternity hospital evacuation
NSW Health admits its patient satisfaction figures are rubbery
Doctor charged with indecent assault
A poor state of health: NSW hospitals the worst in the country
Hospital sends mum bill after baby dies
Hospitals operating at dangerous capacities: report
Angliss Hospital under strain – report
Morphine ‘helped kill new mother Petah Kimm’
‘Superbug’ found at Sydney hospital
NSW hospital could face more lawsuits
Nair to face court on murder count
Bega doctor faces more sex assault charges
Forceps Delivery Linked to Later Pelvic Organ Prolapse
Press cuttings
Tags: caesarean risks, hospital risks, maternal mortality
Filed under: careproviders, consumers, consumers' rights, surgical discourse, surgical monopoly
What does your uterus really do?
Thanks, Gloria, for sharing this on your blog. How many of us know all the stuff in this video? I sure didn’t!
The increase of emergency hysterectomy after caesarean is quite marked in Australia in recent years.
What does your uterus really do?
Tags: hysterectomy, reproductive health
Filed under: consumers, consumers' rights
Collaboration? Oh now I get it. They mean “collaboration”.
There are GPs who support homebirth?
One of the big things the government keeps banging on about in its anti-homebirth drive is “collaboration”. You might think that the existing situation – woman hires midwife, woman and midwife seek obstetric surgeon or hospital in the unlikely event of need, often midwives have relationships built up with hospitals or surgeons so that’s not so hard – looks a lot like appropriate healthcare collaboration as exists in other kinds of healthcare.
Not so.
“Collaboration” as redefined by the weasel words brigade who write legislation and speeches actually means, “doctors telling midwives and women who’s allowed to birth at home and who’s allowed to be such a good girl she’s allowed to attend those women“.
Yup, that’s “collaboration”. Or as the dictionary says:
World English Dictionary
collaboration (kəˌlæbəˈreɪʃən) [Click for IPA pronunciation guide]
—n (often foll by on, with, etc)
1. the act of working with another or others on a joint project
2. something created by working jointly with another or others
3. the act of cooperating as a traitor, esp with an enemy occupying one’s own country
collaborationist
—n
Collins English Dictionary – Complete & Unabridged 10th Edition
2009 © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins
Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009
(My bold)
The basic problem is this: the AMA and RANZCOG are opposed to homebirth. They don’t support it, they’ve worked actively for twenty years or so to undermine and destroy women’s access to consumer-driven, midwife-attended homebirth, they don’t give two hoots about the right of women to basic self determination in healthcare. Now the government tells them to “collaborate” and remember that’s the new and improved definition which really means “be in charge of regardless of women’s wishes” and guess what?
Midwives can’t get doctors to sign collaborative agreements with them. Not even doctors with whom many midwives have previously had fine working relationships. Women can’t get their GPs to sign off for them.
Owing to a lot of rhetoric and a lot of bullshit, obstetric surgeons and GPs are refusing to “collaborate” claiming that homebirth is oh so dangerous they can’t be a party to it. Of course that this stymies the right of women to choose healthcare which suits them is just a beautiful byproduct. More “unintended consequences” like we were told the whole “oops yes homebirth just got wiped out” in the original legislation, no doubt.
So what happens when women seek out doctors with whom to “collaborate”? Well typically the doctor refuses to sign the piece of paper. Women are looking to doctor after doctor, not finding one, being treated really poorly by some of those doctors and simply refused care by others. Some women are being refused hospital bookings even though that too is part of the brave new world of “reform” the government has created. Gee it’s working great so far.
Here’s one woman’s experience of trying to get a doctor to sign off on her homebirth in her country town. Thanks, Tandi, for sharing this. I’d love to be able to say this is uncommon but this is pretty much most women’s experience.
So I made an appointment with the doc in town that has the reputation of being the least ‘conservative’. ANYWAY – this is how our conversation went this morning
Doc “Hello, how are you?”
Me “Very well, thank you.”
Doc “How can I help you?”
Me “The reason I am comming to you so late in pregnancy is because I have been attending the midwives at the antenatal clinic but have recently decided to have a homebirth. I have found a lovely midwife who supports homebirth and….”
Doc (rudely interrupts) “I do not support homebirth”
[I] was blown away – he had NO interest in my history, my health, my reasons NOTHING – then he wrote a few things on his computer, then asked if i wanted to him to check my baby – I said NO THANK YOU. Then he looked at my little girl and asked if she was my first and i said no she is my 4th….. then he told me that I am a grand multi and I am at very high risk of PPH.
[...]
So I managed to hold it together until I left his room but started crying at the desk while trying to pay – my 2 yrs old kept saying “Mummy crying” poor baby, and the receptionist was so kind and concerened but I just wanted to get the f*ck out of there. So I paid $64 to find out that yet another jerk is anti homebirth and I came home and called my IM and sobbed on the phone to her cause I felt so humiliated and infuriated. So anyway my IM was very supportive and we are not going to pursue any more doctors as we have proof that attempts have been made (he signed my hand held record and stated that he will not support HB).
Doctors are also refusing to write scripts for syntocinon which can be used at home in the unlikely event of a PPH because they’re claiming it’s Unsafe and they can’t know how it will be used. Bull.Shit. Unsafe? Let’s talk about hospitals and how safe they are, shall we? How about other kinds of injuries done to women and babies?
Were doctors truly concerned about the use of a drug at home, why would they be concerned when it’s about the only drug actually administered by a trained professional? Most of us just use our seretide, insulin, heart meds, antibiotics, antidepressants, sleeping pills… oh my golly gosh, without a doctor present! I’ve never heard doctors complaining that they can’t give out those scripts to be used by the Untrained Great Unwashed but suddenly a drug being used by someone trained in its use (when the GP isn’t trained in its use anyway) which might help a woman avoid transfering, is out? Right.
Pull the other one, it plays Jingle Bells.
Considering RANZCOG wouldn’t even go to meetings about “collaboration” that were attended by consumer representatives, what did the government think this was going to look like?
I can’t imagine why we don’t want to birth in their nice hospitals, can you?
Collaboration? Oh now I get it. They mean “collaboration”.
Filed under: bullshit, careproviders, consumers' rights, homebirth campaign, reproductive justice, surgical monopoly
Fate of earth – fate of birth
Fate of earth – fate of birth
Tags: michel odent, robbie davis-floyd
Filed under: breastfeeding, consumers' rights, parenting, surgical monopoly
Gratuitous exhortations of cheeriness
I hope that you remember to sew on a sequin over this weekend of mixed feelings.
Gratuitous exhortations of cheeriness
Filed under: just for fun
Australia’s Disease Burden Traced To Low Rates Of Breastfeeding
Australia’s Disease Burden Traced To Low Rates Of Breastfeeding
by Gopalan T on 18 August 2010
Australia’s chronic disease burden has been traced to historical barriers to breastfeeding.
The research, by Dr Julie Smith and Dr Peta Harvey of the Australian Centre for Economic Research on Health at Australian National University (ANU), looked at the public health impact of infants being prematurely weaned during the past five decades in Australia. Using evidence that breastfeeding reduces the risk of chronic disease later in life, and that 90 per cent of current 35-45 year olds were weaned off breastfeeding before six months of age during the 1960s, the researchers measured the legacy for our chronic disease burden.
Dr Smith said that inappropriate and unsupportive health policies, practices and attitudes had undermined breastfeeding in the postwar decades, and led to an unnecessary and avoidable public health burden from chronic disease.
“Many Australians have higher chronic disease risk because they missed out on breastfeeding when they were babies. From what we now know about the effects of premature weaning on chronic disease risk, a significant proportion of the current burden of chronic disease might have been avoided,” she said.
“We still don’t fully understand the long term implications of breastfeeding in infancy. But depending on how we measure exposures for different types of chronic disease, more than one in ten Australians will face heightened risk in later life because they were not breastfed, many from disadvantaged families.
“Not being breastfed has modest effects on increasing later chronic disease risk, but the importance for public health lies in the fact that so few Australian babies are breastfed to six months.”
Australia’s Disease Burden Traced To Low Rates Of Breastfeeding
Tags: artificial feeding, breastfeeding
Filed under: breastfeeding, consumers' rights, parenting
Ways we silence women
This is a beautiful and important post by Heather Armstrong, presented on The Unncessarean. I know many women will relate to it. Unfortunately. Read the rest at the link. Thank you, Heather. Every time this is articulated, another woman comes in from the cold and realises her feelings are valid and important, that she’s not alone and that how she feels really does matter.
Woman Who Didn’t Have a Healthy Baby Reflects on the “Healthy Baby” Trope
Ways we silence women“All that matters is a healthy baby.”
Thank goodness someone said that, otherwise I might have been consumed with the worry that I did not perform my birth correctly. Mothers who know that, in the end, their baby is the only real part of birth, don’t need to feel sad if things didn’t go as planned, right?
No one said that to me when I experienced a horrific “birth” experience because I didn’t have a healthy baby. I became the example, I was the living proof of “what if”. You should be grateful you’re not her; your baby could be her baby. I had notes on Jericho’s birth story that read, “I’m so glad my baby is okay/healthy/alive”. If your baby is any healthier than mine was, then you should be grateful. Experience and hopes be damned.
Telling someone they should be grateful they have a healthy baby is like telling a rape victim she should be grateful she’s still alive; she could have been killed. While that may be true, her experiences and her trauma have been swept under a rug. Does she not matter at all because she wasn’t the worst case scenario? So long as she’s alive, she needn’t grieve her losses?
Tags: caesarean, vbac
Filed under: consumers' rights, surgical discourse, surgical monopoly
