Maternity guidelines misleading: ANZCA
Anaesthetists are involved in the care of half of maternity cases – yet their role has been ignored in new draft guidelines on maternity care.
Anaesthetists are involved in the care of half of the maternity cases in Australia – such as providing epidural pain relief in labour, anaesthesia for caesarean sections and resuscitating critically ill patients – and yet their role has been all but ignored in new draft guidelines on maternity care in Australia.
The President of the Australian and New Zealand College of Anaesthetists (ANZCA), Professor Kate Leslie, said today (Monday, May 31) she was concerned at the contents of the draft National Health and Medical Research Council document, National Guidance on Collaborative Maternity Care.
She said according to the Australian Mothers and Babies 2007 Report, more than 30% of the women who labour in Australia have an epidural and at least 30% of women have a caesarean section which requires anaesthesia. Only anaesthetists or GP anaesthetists are qualified to perform these anaesthetic procedures.
In addition, anaesthetists play a crucial role in the antenatal assessment and planning of women with complex medical and obstetric problems and in resuscitating women (for example, in cases of postpartum haemorrhage.)
“Pain relief during birth is a major issue for almost all birthing women,” Professor Leslie said.
“Anaesthetists and GP anaesthetists provide one of the most effective pain relief options for birth – namely epidural analgesia.
“Resuscitating critically ill women who are birthing is one of the key areas of expertise of anaesthetists. This crucial issue, when it occurs, often needs to be provided urgently. It needs to be addressed more fully.
Anaesthetists were mentioned just four times in the Guidance document which showed an overwhelming bias towards the role of the midwife with insufficient guidance on collaboration with anaesthetists, Professor Leslie said.
“The Guidance document talks about ‘collaborative care’ and ‘choice for women’. It is important to promote an inclusive approach to collaborative care with anaesthetists and pain medicine specialists who have a significant role in half of the births in Australia.”
She said there were also concerns with the quality of information in a summary pamphlet for women.
“A claim that midwives ‘can provide all aspects of ‘routine’ pregnancy, labour and birth and postnatal care’ is misleading,” Professor Leslie said.
“Midwives play an important role in the birthing process, but they cannot provide epidural analgesia which some low risk women having a ‘routine’ pregnancy want.”
ANZCA, representing specialist anaesthetists and pain medicine specialists, is a major stakeholder of maternity health services and was actively engaged in the recent Commonwealth Government Maternity Services Review.
The College also responded to the Maternity Services Report that was released subsequent to the consultation process and is represented on the Core Competencies and Educational Framework for Maternity Services Project Steering Group (Department of Health and Ageing).
“We were both surprised and concerned that we were not directly contacted regarding this important consultation process on the Guidance document,” Professor Leslie said.
“We have since contributed comments and hope that these will be incorporated into the formal document.”