Focus on people, not systems: plea for improvement to maternal healthcare

Adriana cradling newborn Evelyn at Mercy Hospital. Photo: Adriana Wigney
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A midwifery expert says there's now an opportunity to make maternal healthcare much less stressful for everyone after pandemic revealed big problems. Loren Botica reports, in the first of a two-part series

The coronavirus pandemic in Australia has revealed problems “in an already compromised [healthcare] system”, a midwifery expert said.

Curtin University midwife research fellow Dr Zoe Bradfield said, “what we have in the industrialised world is an industrialised approach to health care.”

Dr Bradfield, who has researched the impact of Covid on maternity care and is vice-president of the Australian College of Midwives, said the pandemic had provided an opportunity for Australia’s healthcare system to pivot from “system-centred” to “human-centred”, benefiting patients and medical professionals.

“We don’t often think about maternity care until we’re there, but the reality is this is where women’s rights begin and end,” she said.

New mum Adriana Wigney felt the impact of an industrialised system in early March when the hospital she was attending “stuffed up” her antenatal procedures.

On one occasion, when she was worried about the lack of movement from her baby, Ms Wigney went to the emergency department only to be refused attention until she had a Covid-19 screening.

“It makes you feel that … oh you’re not an emergency unless you’ve got a [Covid] screening done,” she said.

Ms Wigney said Covid-19 hospital measures made it near impossible to have family around. That was until she “made it a point and really pushed” to have first-time father Ben with her.

Limited visitor numbers and a transition from physical appointments to telehealth were just some of the many changes to medical practice introduced during Covid.

Focus on people, not systems: plea for improvement to maternal healthcare
Dr Zoe Bradfield Midwifery Academic and research fellow Curtin University Photo: Curtin University

Dr Bradfield’s 2020 report showed that mothers and support people were less satisfied with the Covid-19 changes when compared to medical staff.

“As practitioners, we work in the models that are available to employ us,” she said. “It may be that we think we’re doing okay as practitioners, and it may be that consumers don’t agree with that.”

She said further concerns for health practitioners were that costs invested in pandemic preparedness would have to be recouped.

What might that mean for healthcare services if we have less money to do the work?

Pre-pandemic, Australian governments were addressing the call for a “women-centred approach” within maternity services.

COAG’s Health Council, dissolved last May by the Morrison government, released a Women Centred Care Strategy in 2019. The strategy recommended providing accessible care that “should reflect their [mother’s] individual needs”.

Dr Bradfield advocates for a “continuity of care model”, providing expectant mothers access to the same midwife and health professionals throughout their birthing experience.

Research found “women who were cared for in continuity models experienced less stress”.

Dr Bradfield said she was optimistic that the continuity of care model could become the standard procedure for maternity care. 

Ms Wigney, now the mother of a baby girl, Evelyn, said she suffered a range of problems in her hospital care, including an incorrectly administered epidural, which caused her bad headaches, dizziness, and a blood clot post-hospital stay.

She said she asked for another nurse after two cannula insertions went wrong but the request was refused.

“I felt like I wasn’t heard enough,” Ms Wigney said.

A spokesperson for the hospital said: “As an organisation, patient care is our number one priority, so we are sorry to hear that this patient was in any way dissatisfied with the care received.”

“Patients were encouraged to provide feedback, and there were a range of established ways to do so,” the spokesperson said.