The Royal Australian and New Zealand College of Obstetricians and Gynaecologists 6 October 2008 ABN 34 100 368 969 Excellence in Women’s Health Collage House 254 — 260 Albert Steet Fast Malbourne Vie 3002 Australia Telephone: +61 3 9417 1699) Focsimile: + 61 3 9419 .0672 E-mail: ronzcog@ranzcog.edv.cy Dear RANZCOG Fellows and members We are writing to you about the review of Maternity Services that has been commissioned by the Federal Government. The document ‘Improving Maternity Services in Australia - a discussion paper from the Australian Government’ is available on the Department's website: itp www health. gov.awmatemityservicesreview. This has the potential to be one of the most important issues to affect RANZCOG Fellows and members since the Medical Indemnity crisis, It is important that the Fellowship is aware of the issues surrounding this review and the College's response to it When the Rudd Labor Government was clected in late 2007, they indicated that there would be changes in the way health care was delivered in Australia. They had foreshadowed Maternity Services reform with a possible increase in midwife led care. The Federal Health Minister, the Hon Nicola Roxon MP, released the discussion paper entitled: ‘Improving Matemity Services in Australia’ in September 2008. Submissions to this enquiry have been requested and close on 31 October 2008. The document identifies inequalities in maternity care, particularly in rural and Indigenous women and looks at ways to address that. It raises concems about Australia’s high rate of obstetric intervention and asks a number of questions about Workforce and infrastructure. Ways of improving workforce support in rural and urban settings are flagged to be explored. Importantly for the College Fellowship, it is looking at ways to expand midwife led care across antenatal, birthing and postnatal services and it is clear that the Minister is firmly of the view that change should occur. It also identifies key problems in postnatal care particularly with poor breastfeeding rates and identification and treatment of postnatal depression. Given that RANZCOG is a combined College, the RANZCOG Council has been acutely aware of the problems that have arisen in New Zealand following the introduction of midwife led care. Some of the problems our New Zealand colleagues have experienced have been: * very poor or no perinatal data collection with virtually no consistent audit of the radical changes made to New Zealand Maternity Services; ancarly complete loss of GP obstetricians; a great reduction in the availability of gynaecological services in rural areas; a number of health enquiries being commissioned to investigate poor outcomes; and @ quarantined maternal mortality report which reportedly shows a doubling in matemal mortality since the introduction of midwife led care.Clearly the College is opposed to the introduction of a New Zealand type system for Australian ‘Matemity Care. Since release of the discussion paper, the RANZCOG Executive has met by teleconference to formulate a response to the discussion paper. This response will be sent to you in the next week for your comment, is in Canberra to further the aims of In the next three weeks, there will be six round table discus the discussion paper. The topics for these are: * Effective Data Collection, Monitoring, Reporting and Research, Assessing and Managing High Risk Pregnancy, Workforce Standards, Quality and Interprofessional Collaboration, Altemate and Midwife Led Models of Care, Indigenous Perspectives, and Peer and Social Support in the Perinatal Period, RANZCOG will have representatives at each of these forums and the Executive has carefully considered our position for each. The Executive Committees of RANZCOG and NASOG have had discussions, to try to ensure that obstetricians have a united voice in opposing changes to maternity care that may have a negative impact on outcomes. The Executive and Council of RANZCOG welcomes your feedback on any aspect of this Matemity Services review and request your support in our efforts to maintain safe and effective systems of Maternity Care in Australia, Because of the tight timeframes dictated by the Government, your comments need to reach us by Friday 17 October 2008 via e-mail president@ranzcog.edu.au or ranzeog@ranzcog.edu.au . ‘Yours sincerely Lae Th WWE Dr Christine Tippett Dr Ted Weaver President President Elect