Have we lost sight of the women? An observational study about normality-centred care in Australian maternity services

Ananthram, Harsha, Vangaveti, Venkat, and Rane, Ajay (2022) Have we lost sight of the women? An observational study about normality-centred care in Australian maternity services. Australian and New Zealand Journal of Obstetrics and Gynaecology, 62 (1). pp. 40-46.

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Abstract

Background Prioritising normal birth has led to harm in some instances in the United Kingdom. While Australian organisations also promote normal birth, its negative impact is less well understood here. Aims This study explores the problems that may arise from the promotion of normal birth and the quality of clinical incident investigations.

Materials and Methods This study uses a survey-based research design and has received 1278 responses. The main outcome measures include perceptions on bias against interventions, delays in interventions, systemic attempts to reduce caesarean rates, and clinical incident investigations.

Results The perception among both obstetric and midwifery cohorts is that the promotion of normal birth may sometimes or frequently lead to bias against intervention for women (93.8% vs 63.2%), bias against intervention for clinicians (81.1% vs 53.1%), delays in interventions (86.8% vs 37.4%), maternal request caesarean sections being discouraged (81.2% vs 66.9%), an increased emphasis on vaginal birth after caesarean (88.1% vs 69.3%), and a culture of vaginal births 'at all costs' leading to poor outcomes for mothers and babies (79.5% vs 24.7%). Respondents believe clinical incident investigations to be 'frequently' independent (48% vs 48.2%) but engagement of women in these processes is often missing or 'rarely' seen (46.6% vs 51.7%).

Conclusions This study finds that Australian maternity healthcare providers believe institutional encouragement of normal birth has created work practices in maternity care that compromise patient safety and reduce the agency of the woman in the choices she makes. Current regulatory standards must change to reflect core ethical and legal obligations around informed consent.

Item ID: 72120
Item Type: Article (Research - C1)
ISSN: 1479-828X
Keywords: caesarean,delivery,pregnancy,prenatal care,injury claims
Copyright Information: © 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Date Deposited: 09 Feb 2022 08:49
FoR Codes: 42 HEALTH SCIENCES > 4204 Midwifery > 420402 Models of care and place of birth @ 70%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3215 Reproductive medicine > 321502 Obstetrics and gynaecology @ 30%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200306 Midwifery @ 100%
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