Advertisement

A comparison of the Woman-centred care: strategic directions for Australian maternity services (2019) national strategy with other international maternity plans

      Abstract

      Background

      In 2019 the Australian government released a guiding document for maternity care: Woman-centred care strategic directions for Australian maternity services (WCC Strategy), with mixed responses from providers and consumers. The aims of this paper were to: examine reasons behind reported dissatisfaction, and compare the WCC Strategy against similar international strategies/plans. The four guiding values in the WCC strategy: safety, respect, choice, and access were used to facilitate comparisons and provide recommendations to governments/health services enacting the plan.

      Methods

      Maternity plans published in English from comparable high-income countries were reviewed.

      Findings

      Eight maternity strategies/plans from 2011 to 2021 were included. There is an admirable focus in the WCC Strategy on respectful care, postnatal care, and culturally appropriate maternity models. Significant gaps in support for continuity of midwifery care and place of birth options were notable, despite robust evidence supporting both. In addition, clarity around women’s right to make decisions about their care was lacking or contradictory in the majority of the strategies/plans. Addressing hierarchical, structure-based obstacles to regulation, policy, planning, service delivery models and funding mechanisms may be necessary to overcome concerns and barriers to implementation. We observed that countries where midwifery is more strongly embedded and autonomous, have guidelines recommending greater contributions from midwives.

      Conclusion

      Maternity strategy/plans should be based on the best available evidence, with consistent and complementary recommendations. Within this framework, priority should be given to women’s preferences and choices, rather than the interests of organisations and individuals.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. COAG Health Council, Woman-Centred Care: Strategic Directions for Australian Maternity Services, Department of Health, Canberra, 2019. Available from: 〈https://www.health.gov.au/sites/default/files/documents/2019/11/woman-centred-care-strategic-directions-for-australian-maternity-services.pdf〉.

      2. The Australian Health Ministers’ Conference, National Maternity Services Plan, Canberra, 2011. Available from: 〈https://www1.health.gov.au/internet/main/publishing.nsf/Content/8AF951CE492C799FCA257BF0001C1A4E/$File/maternityplan.pdf〉.

      3. A. Staines, Personal communication from maternity consumer network president, in: H. Dahlen (ed.), Email, 2021.

        • Dahlen H.
        • Schmied V.
        • Tracy S.
        • Jackson M.
        • Cummings J.
        • Priddis H.
        Home birth and the National Australian Maternity Services Review: too hot to handle?.
        Women Birth. 2011; 24: 148-155
        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife-led continuity models versus othermodels of care for childbearing women during pregnancy, birth and early parenting.
        Cochrane Database Syst. Rev. 2016; 4https://doi.org/10.1002/14651858.CD004667.pub5
        • Scarf V.L.
        • Rossiter C.
        • Vedam S.
        • Dahlen H.G.
        • Ellwood D.
        • Forster D.
        • et al.
        Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: a systematic review and meta-analysis.
        Midwifery. 2018; 62: 240-255
        • Hodnett E.D.
        • Downe S.
        • Walsh D.
        Alternative versus conventional institutional settings for birth.
        Cochrane Database Syst. Rev. 2012; 8CD000012https://doi.org/10.1002/14651858.CD000012.pub4
      4. Commonwealth of Australia, Improving maternity services in Australia: the report of the maternity services review, Canberra, 2009. Available from: 〈https://www1.health.gov.au/internet/main/publishing.nsf/Content/624EF4BED503DB5BCA257BF0001DC83C/$File/Improving%20Maternity%20Services%20in%20Australia%20-%20The%20Report%20of%20the%20Maternity%20Services%20Review.pdf〉.

        • Dahlen H.
        • Jackson M.
        • Schmied V.
        • Tracy S.
        • Priddis H.
        Birth centres and the National Maternity Services Review: response to consumer demand or compromise?.
        Women Birth. 2011; 24: 165-172
      5. Australian Institute of Health and Welfare. Australian Mothers and Babies 2018-in Brief (Perinatal Statistics Series no 36 Cat no PER 108), AIHW, Canberra, 2020. Available from: 〈https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-and-babies-2018-in-brief〉.

      6. Australian Institute of Health and Welfare, Australian Mothers and Babies–2021, AIHW, Canberra. Available from: 〈https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies〉.

        • Fox H.
        • Topp S.M.
        • Callander E.
        • Lindsay D.
        A review of the impact of financing mechanisms on maternal health care in Australia.
        BMC Public Health. 2019; 19: 1540-1553
      7. Australian Institute of Health and Welfare, Disease Expenditure in Australia, AIHW, Canberra, 2019. Available from: 〈https://www.aihw.gov.au/reports/health-welfare-expenditure/disease-expenditure-australia/contents/australian-burden-of-disease-groups〉.

      8. Independent Hospital Pricing Authority, Bundled Pricing for Maternity Care, Final Report of IHPA and the Bundled Pricing Advisory Group, 2017. Available from: 〈https://www.ihpa.gov.au/sites/default/files/bundled_pricing_for_maternity_care_-_final_report.pdf〉.

        • Kennedy H.P.
        • Balaam M.C.
        • Dahlen H.
        • Declercq E.
        • de Jonge A.
        • Downe S.
        • et al.
        The role of midwifery and other international insights for maternity care in the United States: an analysis of four countries.
        Birth. 2020; 47: 332-345
      9. National Health Service (NHS), National maternity review: better births improving outcomes of maternity services in Englanda five year forward view for maternity care, 2016. Available from: 〈https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf〉.

      10. Welsh Government, Maternity care in Wales: a five year vision for the future (2019–2024), 2019. Available from: 〈https://gov.wales/sites/default/files/publications/2019-06/maternity-care-in-wales-a-five-year-vision-for-the-future-2019-2024.pdf〉.

      11. Scottish Government, The best start: a five-year forward plan for maternity and neonatal care in Scotland, 2017. Available from: 〈https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2017/01/best-start-five-year-forward-plan-maternity-neonatal-care-scotland/documents/00513175-pdf/00513175-pdf/govscot%3Adocument/00513175.pdf〉.

      12. Department of Health, Ireland, Creating a better future together: national maternity strategy 2016–2026, 2016. Available from: 〈https://assets.gov.ie/18835/ac61fd2b66164349a1547110d4b0003f.pdf〉.

      13. Department of Health, Social Services and Public Safety, A strategy for maternity care in Northern Ireland 2012–2018, 2012. Available from: 〈https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/maternitystrategy.pdf〉.

      14. Public Health Agency of Canada, Chapter 1: family-centred maternity and newborn care in Canada: underlying philosophy and principles, 2017. Available from: 〈https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/maternity-newborn-care/maternity-newborn-care-guidelines-chapter-1-eng.pdf〉.

      15. Ministry of Health and District Health Boards, New Zealand maternity standards: a set of standards to guide the planning, funding and monitoring of maternity services, Wellington, New Zealand, 2011. Available from: 〈https://www.health.govt.nz/system/files/documents/publications/nz-maternity-stds-sept2011.pdf〉.

      16. World Healh Organisation, WHO recommendations: intrapartum care for a positive childbirth experience, Geneva, 2018. Avaliable from: 〈https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf;jsessionid=5559193E3921970A540FB8C59D62904C?sequence=1〉.

        • Cahill H.A.
        Male appropriation and medicalization of childbirth: an historical analysis.
        J. Adv. Nurs. 2001; 33: 334-342
        • Johanson R.
        • Newburn M.
        • Macfarlane A.
        Has the medicalisation of childbirth gone too far?.
        BMJ. 2002; 324: 892-895
        • Jenkinson B.
        • Kruske S.
        • Kildea S.
        The experiences of women, midwives and obstetricians when women decline recommended maternity care: a feminist thematic analysis.
        Midwifery. 2017; 52: 1-10
        • Oladapo O.T.
        • Tunçalp Ö.
        • Bonet M.
        • Lawrie T.A.
        • Portela A.
        • Downe S.
        • et al.
        WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing.
        BJOG: Int. J. Obstet. Gynaecol. 2018; 125: 918-922
      17. United Nations, Global strategy for women’s, children’s and adolescents’ health (2016–2030), Geneva, 2016. Available from: 〈https://www.who.int/life-course/partners/global-strategy/globalstrategyreport2016-2030-lowres.pdf?ua=1〉.

        • Simpson M.
        • Schmied V.
        • Dickson C.
        • Dahlen H.G.
        Postnatal post-traumatic stress: an integrative review.
        Women Birth. 2018; 31: 367-379
      18. The International Childbirth Initiative (ICI), 12 steps to safe and respectful motherbaby-family maternity care, 2018. Available from: 〈https://icichildbirth.org/wpcontent/uploads/2021/04/ICI_International-Childbirth_2021.4.pdf〉.

      19. The White Ribbon Alliance, Respectful maternity care charter: universal rights of mothers and newborn: the Global Respectful Maternity Care Council, 2018. Available from: 〈https://www.whiteribbonalliance.org/respectful-maternity-care-charter/〉.

      20. White Ribbon Alliance, The respectful maternity care charter: the universal rights of childbearing women, Washington, 2011. Available from: 〈http://www.healthpolicyproject.com/pubs/46_FinalRespectfulCareCharter.pdf〉.

        • Rigg E.
        • Dahlen H.G.
        Woman centred care: has the definition been morphing of late?.
        Women Birth. 2021; 34: 1-3
      21. United Nations, Universal declaration of human rights, Geneva, 2015. Available from: 〈https://www.un.org/en/udhrbook/pdf/udhr_booklet_en_web.pdf〉.

        • Hevia M.
        • Constantin A.
        Gendered POwer Relations and Informed Consent: the I.V. v. Bolivia case.
        Health Hum. Rights. 2018; 20: 197-203
        • Dawson K.
        • Forster D.
        • McLachlan H.
        • Newton M.
        Operationalising caseload midwifery in the Australian public maternity system: findings from a national cross-sectional survey of maternity managers.
        Women Birth. 2018; 31: 194-201
      22. R. Davis-Floyd, L. Barclay, J. Tritten (Eds.), Birth Models That Work, University of California Press, 2009. Available from: 〈https://california.universitypressscholarship.com/view/10.1525/california/9780520248632.001.0001/upso-9780520248632〉.

        • Donnolley N.
        • Butler-Henderson K.
        • Chapman M.
        • Sullivan E.
        The development of a classification system for maternity models of care.
        Health Inf. Manag. J. 2016; 45: 64-70
        • Rigg E.C.
        • Schmied V.
        • Peters K.
        • Dahlen H.G.
        A survey of women in Australia who choose the care of unregulated birthworkers for a birth at home.
        Women Birth. 2020; 33: 86-96
      23. Dahlen H. Kumar-Hazard B. Schmied V. Birthing Outside the System: The Canary in the Coal Mine. Routledge, New York2020
        • Reiger K.M.
        • Lane K.L.
        Working together: collaboration between midwives and doctors in public hospitals.
        Aust. Health Rev. 2009; 33: 315-324
        • Stevens G.
        • Thompson
        • Kruske S.
        • Watson B.
        • Miller Y.
        What are pregnant women told about models of maternity care in Australia? A retrospective study of women’s reports.
        Patient Educ. Couns. 2014; 97: 114-121
        • Steel A.
        • Adams J.
        • Frawley J.
        • Wardle J.
        • Broom A.
        • Sidebotham M.
        • Sibbritt D.
        Does Australia’s health policy environment create unintended outcomes for birthing women?.
        Birth. 2016; 43: 273-276
      24. Australian Government National Health and Medical Research Council, National Guidance on Collaborative Maternity Care, Department of Aging, 2010. Available from 〈https://www.nhmrc.gov.au〉.

      25. Australian Government Productivity Commission, Introducing competition and informed user choice into human services: reforms to human services in Productivity Commission Inquiry Report Overview & Recommendations, 2018: Canberra No 85, 2017. Available from: 〈https://www.pc.gov.au/inquiries/completed/human-services/reforms/report/human-services-reforms-overview.pdf〉.

      26. Australian Government Productivity Commission, Efficiency in health, in: Productivity Commission Research Paper, 2015. Available from: 〈https://www.pc.gov.au/research/completed/efficiency-health/efficiency-health.pdf〉.

        • Dahlen H.G.
        • Tracy S.
        • Tracy M.
        • Bisits A.
        • Brown C.
        • Thornton C.
        Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study.
        BMJ Open. 2014; 4: 5
        • Wilkes E.
        • Gamble J.
        • Adam G.
        • Creedy D.
        Reforming maternity services in Australia: outcomes of a private practice midwifery service.
        Midwifery. 2015; 10: 935-940
      27. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Consultation Paper on the Pricing Framework for Australian Public Hospital Services 2017-18–RANZCOG response, Independent Hospital Pricing Authority (Ed.), 2017. Available from: 〈https://www.ihpa.gov.au/sites/default/files/Documents/consultation_paper_on_the_pricing_framework_2017-18_0.pdf〉.

        • McKinnon L.C.
        • Prosser S.J.
        • Miller Y.D.
        What women want: qualitative analysis of consumer evaluations of maternity care in Queensland, Australia.
        BMC Pregnancy Childbirth. 2014; 14: 366
        • Jenkinson B.
        • Kruske S.
        • Kildea S.
        Refusal of recommended maternity care: time to make a pact with women?.
        Women Birth. 2018; 31: 433-441