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Emma Brathwaite’s story The challenges of women’s health and perinatal care are not unknown to me. I’ve worked in maternal child health and sexual reproductive health for more than 15 years- not in Australia but in development and humanitarian contexts across the Pacific, Asia and the Middle East. I’ve seen truly desperate situations where pregnancy is a risk, where maternal death is a reality and where motherhood is just not safe. Last year I left my job with the United Nations to return to Australia to have my first baby. I’m a first time mother and my partner and I felt it was important to head home to Australia for the pregnancy and birth. Our friends and family nodded in agreement- “the best care” they would say “is back in Australia. You’ll have the best obstetricians, one-on-one care and access to a world class health system if you come back to Australia”. We agreed. It really was an easy decision. The global evidence is very clear: continuity- care models have much better outcomes for women and babies – so I already knew what type of pregnancy care I was seeking in Australia before I even arrived home. I wanted a midwife to be my primary case manager throughout the pregnancy, birth and to manage the care in the early post-partum period. If I moved into a high-risk category then,of course,I would move under the care of an obstetrician. This was an easy decision, yes, however much more difficult in practice. Navigating the Australian health system is no easy task. At first I registered with the Royal Women’s Hospital because I knew they had a midwife model of care and was told I might be placed in midwife led care (the COSMOS programme). My dear friend – a senior midwife at the Royal Women’s Hospital – suggested I could explore a shared care option with my GP but also highlighted some of the realities of the COSMOS programme: I was unlikely to get into the programme because- apart from my age – I was not high risk; I was unlikely to find out if I got into COSMOS until very late in the pregnancy and that I would probably see a different midwife at each of my antenatal visits and the birth. It was midwife-led care but not the continuity care I was seeking from one primary midwife. I had well-meaning family fast-track referrals to well-known obstetricians. While obstetricians are a really critical part of the health system, I didn’t really feel my perinatal care needed to be managed by one- I was low risk. So thanked the well-meaning family members and said no thanks. I had my private health insurance advising they would only cover private obstetricians, not midwives and that my out-of-pocket expenses would be fairly significant. I had friends volunteer their own horror stories of pregnancy complications, birth and breastfeeding. It was confusing. My dear midwife friend strongly urged me to speak to My Midwives in Brunswick and to go through all the options. If she had a choice, she explained, she would opt for a private midwife and birth in a public hospital. I was keen to understand how private midwives operated in the public health system in Australia and more interested in why the model hadn’t been replicated and expanded to more public hospitals across Australia. After the first consultation with My Midwives, it was an easy decision for me but an option I wished more women in Australia could access. From then on, Hannah Quanchi from My Midwives was my primary midwife. My pregnancy was fairly textbook until the end when I had a full placental abruption and I had an emergency cesarean surgery and complications- something that could have been very traumatic. At the time I felt in control (as much as I could be) and calm and had full confidence in my midwife and her professional relationships with all the specialists and staff at the hospital. It’s so important to have someone you know and someone who knows you and your medical history to guide you through birth. There’s so much going on, so many hormones that even though I knew what I wanted, it was hard to communicate and advocate for myself when I was told I had to have an emergency surgery ASAP. I thank Hannah- my midwife- for providing me as much autonomy as possible at that time. We feel really very lucky to have a healthy baby boy when it could have been a very different story if I hadn’t trusted Hannah’s advice and judgment and if I didn’t have a midwife who knew my medical history, my birth preferences and excellent professional relationships to fast-track high quality care when it was urgently needed. I really hope the Australian government supports the inclusion of this model of care and scales-up affordable midwife led continuity care within the public health system. Doing this gives the best chance for women to have a positive pregnancy, birthing and breastfeeding experience that sets the foundation for health and wellbeing for families and communities. Question: how would you promote woman centred, therapeutic relationship when caring for these women. distinct responses, inclusive of non-verbal skill/s, you could use to minimise barriers to communication. Please provide APA 7 referencing
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