Drive significant system change in Maternity Care
Introduction
While the current government is to be congratulated on its focus on improving maternity care services, they are hampered in their efforts by the resistance for change and a lack of accountability within the system.
If we continue doing what we are currently doing, we will continue to provide poor outcomes. We know, some of the best and most effective solutions cost less than what is being currently spent on maternity care.
The problem goes deeper than funding. What is required is significant system change, driven by a focus on governance and accountability to address the poor outcomes of current maternity care practices.
It is recognized internationally that the setting and implementation of quality standards are levers to improve care. Standards help to set public, provider and professional expectations and enable services to safeguard people using their services and to improve the quality of care they provide.
Our hope is that every pregnancy is treated with dignity, respect and compassion.
Background
In 2019, the Australian Government developed the Woman-centred care: Strategic directions for Australian maternity services – (The Strategy) with the vision for all women to receive respectful maternity care. The Strategy provides the framework and principles of care. Additionally the Australian Government Department of Health and Aged Care has funded the Australian Pregnancy and Postnatal Care Evidence-based clinical recommendations (The Guidelines), which inform the practices of maternity care.
Current Situation
Despite these initiatives, a recent survey evaluating the effectiveness of the Strategy found that Australian maternity services did not perform well in any aspect of the policy, leaving women vulnerable to less than optimal care. The issue arises from the split of responsibility between state and federal governments, for policy, funding and delivery of maternity care. There is a need for a focus on governance and accountability to address the lack of implementation.
Issues
Currently, Australia has national standards for stillbirth and perineal tear. However, there is no standard to achieve woman-centred pregnancy care. Without a standard, women are subjected to unnecessary interventions leading to the maximum number of women labelled “at risk” and becoming candidates for inappropriate, unnecessary, unwanted, costly and potentially harmful interventions, with no corresponding health improvement for mother or baby.
Proposal
A Woman-centred Maternity Care Standard defines the systems required by health service organisations to monitor the provision of appropriate care, review performance, and make improvements in the care provided. High quality safe care will be evaluated during health service accreditation. While accreditation, does not guarantee that no one will experience disrespectful and unsafe maternity care, it ensures safety and quality systems are in place that promote respectful and safe care.
The Maternity Care Standard can be complemented by a Clinical Quality Registry, which systematically monitors and reports on the appropriateness and effectiveness of maternity care for out of hospital birth, public and private hospital births and incorporates doctor and midwife led care. This provides clinicians and health service organisations with feedback on clinical outcomes and unwarranted variation in care, allowing benchmarking to see where they can improve care. Most importantly, a register provides consumers with data to make informed decisions on their care options.
Collectively these approaches provide the building blocks for the provision of consistently safe, evidenced informed, quality maternity services. A Maternity Standard, Clinical Register and Accreditation together promotes cultural safety, good governance, and accountability.
Recommendations
- Develop and implement a Woman-centred Maternity Care Standard, as part of the current National Safety and Quality Health Service Standards.
- Establish a Clinical Quality Register to assist informed decisions and best practices.