A disturbing story appeared in the Courier Mail on Sunday 29 May 2022. Entitled Doctors slammed for ‘sticky beaking’ into births, it suggested that the human rights of birthing mothers in Queensland public hospitals were being breached by obstetricians entering the room and speaking with the labouring women.
At a time when public maternity units are filled past capacity and struggling to meet the demand, the content of the article showed a fundamental misunderstanding of the realities of public healthcare and belittled the crucial role of our Registrars in the care of mothers and babies.
Many women in our public units are being discharged only a few hours after a vaginal delivery and 24 hours after an elective c section. Seeing an obstetrician during pregnancy and labour is not guaranteed and many women are cared for solely by midwives throughout their entire pregnancy and delivery journey.
This is not the case for women having babies in the private sector, where their chosen specialist obstetrician liaises with their labour ward midwife during labour and is on call for them specifically. Private obstetricians rarely have to care for more than 1 labouring woman at a time. However, private maternity units are closing at an increasing rate as many families can no longer afford to pay the out-of-pocket costs caused by stagnant and woefully inadequate Medicare and private health insurance rebates.
As a result, our large public hospitals can have as many as 20 women labouring at a time. The Registrar is responsible for overseeing the well-being of EACH of these women and their babies, even if the woman is deemed “low risk” and is being cared for by her midwife. Registrars rely on the midwives they work with to be able to pick up complications early and notify them of any concerns.
It is imperative that the Registrar knows what is going on in each room at all times, in case an emergency develops with one or more women.
The Registrar introducing themselves to the labouring woman is trying to make sure that, should they have to administer obstetric treatment, it is not at the hands of a complete stranger and someone they are first meeting in an even more anxious and tense time.
The Registrar needs to be able to prioritise the labour ward demand for their attention so that if 2 or women need obstetric assistance at the same time, the best use of their time and access to operating theatres etc can be made so that the most urgent woman receives care first. This can only be done if the registrar (who is the person who makes the decision that emergency obstetric care is needed) is fully across all that is happening in the entire labour ward.
Everyone involved with looking after patients would, I trust, be respectful in their dealings and knock before entering a room and introduce themselves by name and position. If that is not the case then it certainly needs to be addressed, but the article and commentators have not said that this was the issue.
A career in obstetrics is hard enough as it is. Not only is it one of the longest medical training programs at 6 years; anxiety and stress levels are high, working shifts around the clock is the norm and the constant threat of career ending litigation is never far from trainees’ minds.
Once they finish this arduous training program, positions in the public sector for fully trained specialists are minimal and private obstetrics is in real danger of collapsing under affordability issues with sky rocketing insurance and practice costs at a time when private health insurance for patients is simply too expensive and does not cover the cost of providing the service.
Unless changes occur in the near future, obstetrics, like general practice, will simply cease to be an attractive proposition for junior doctors to train in when so many other specialties offer more family friendly hours, shorter training times, much lower risk of litigation and lucrative private practice options.
Continuing to apply unnecessary pressure on this dedicated group of medical professionals just trying to do the best for the women in their care, certainly will not increase the numbers of doctors wanting to go into the specialty and will ultimately lead to women having babies experiencing less access to this mother and baby lifesaving specialty, with more units, both public and private, closing as staffing them becomes even more difficult.
Obstetricians have higher than the average doctor suicide rates. This tragedy needs to be addressed and while we all need to do a better job at looking after ourselves and our colleagues, it is important that as a nation we do our best to weed out toxic work environments and ensure every staff member feels valued, supported and appreciated.
So instead of devaluing the input of our junior obstetric colleagues in labour ward, perhaps acknowledging that everyone involved in caring for labouring women is doing their best to ensure a happy and safe birth for both mother and child would be the better way to go.