28 November 2013

Maternity review

| johnboy
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Chief Minister Gallagher has made known her response to the ACT Centenary Hospital for Women and Children – Maternity Model of Care and Demand Review:

“The key finding of the review into the model of care and demand for these services is that there is a safe and effective service that exists within the Canberra Hospital maternity service and this is something the government is committed to protecting.

“The high level of demand for the new Centenary Hospital for Women and Children is also a strong vote of confidence in the facility and the government’s investment in this essential new piece of health infrastructure.

“The way the ACT is providing maternity services is a progressive approach with proven benefits for both mothers and children and is widely used in hospitals in the UK and New Zealand.

“The model focuses on having continuity of care- that is having the same midwife during pregnancy, birth and the postnatal period. The model also includes early discharge for well women and babies with follow up provided by midwives visiting the home.”

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BimboGeek said :

EvanJames said :

Hospital care is stunningly expensive. If there’s no medical need for someone to be consuming that stunningly expensive care, then the medically trained people will make that call and send you on your way. While being waited on hand and foot is nice, it’s not an entitlement.

Having babies is a choice, not a sentence. It’s not cancer.

Actually, when my mother in law had cancer, she was sent home earlier than she wanted, too. She was enjoying the rest and was still very tired and intimidated about the idea that she had a lot more work to do when she went home, but they knew she had a supportive husband, that his sister was very close and generous, that her kids and their partners had been in and brought lots of fruit, flowers and books, and spent lots of time with her, and they knew she didn’t need 24 hour observation, just checkups, and that she could easily come in for those.

I am not qualified to comment on the maternity situation, but after having neurosurgery at Canberra Hospital a few years ago, I made sure that when the surgeons came around for their morning rounds
that I was always sitting in the chair next to the bed and not in bed (even the morning after in intensive care). I ended up getting out of hospital two days earlier than originally scheduled after one of the surgeons commented that I was never in bed (and obviously had recovered). It looks like I will have to do it all again (probably early next year), so I hope I will be able to use the same ‘ploy’. It is not that I don’t appreciate the care given by ALL staff at Canberra Hospital, but for me, being out of hospital is better than being in.

A friend has just given birth there, and despite it being uncomplicated they were in there for 3 days, to the point where they actually had to say “Look, we’re leaving.”

Stress less people!

sepi said :

Not everyone is a martyr/superwoman type person who has a baby and is back to normal routines only hours later.

No, you’re so right. Not everyone. Just around a billion women in developing countries …

miz said :

You definitely need more than 24 hours to establish the breastfeeding side of things for the first baby. Subsequent babies you may want to go early, but possibly not if things went awry previously. There should be more care about who gets sent home within 24 hours. My understanding about the UK scheme s that there are lots of follow up home visits by midwives after the mother goes home. Do Canberra mums get these, or are we simply applying the UK hospital aspect because of the savings?

Yes this happens in Canberra, it is called the midcall program and applies for a week after birth, and then after that there are the health clinics which have drop-in sessions every few days and a heap of other programs to help mum and baby (and dads too). As mentioned above if there are issues after going home the midcall midwife just needs to make one call to the duty doctor and mother and baby are back in hospital, and as also mentioned when on the midcall program mum and baby are still technically hospital patients too.

As for breastfeeding you are right it does take more than 24 hours to get the baby feeding properly. Though personally don’t think you need to be in hospital for that to be established. Indeed feeding is the issue that lead my wife and baby to go back in. Being in hospital wouldn’t have made a difference, but having the midcall support to identify the issue and being able to go back in when it was clear there was an issue was.

Also I don’t think it is purely a cost saving measure either, they do it because they genuinely believe that it is best to not be in a hospital, hospitals are full of sick people! Beside if everyone was ‘allowed’ to stay 4 nights the size of the maternity ward at the hospital would have to be at least 2-3 times bigger and yes an increased cost in staff. Currently the post natal ward has about 20 or so beds (most single rooms too and quite nice) so would have to be 60+ to handle 3 night stays for everyone.

They of course also have another ward for babies that are sick and need extra care and an overflow area in the adjacent ward.

Yup Canberra mums get lots of follow-up visits and checkups.

I’m not surprised private hospitals try to sell you a 4 day stay in bed for no reason. We already know they sell a lot of caesarians and I wouldn’t be surprised to learn that they are also selling more drugs. They are businesses trying to get your money, not provide services for the common good.

Comic_and_Gamer_Nerd11:20 pm 30 Nov 13

miz said :

You definitely need more than 24 hours to establish the breastfeeding side of things for the first baby. Subsequent babies you may want to go early, but possibly not if things went awry previously. There should be more care about who gets sent home within 24 hours. My understanding about the UK scheme s that there are lots of follow up home visits by midwives after the mother goes home. Do Canberra mums get these, or are we simply applying the UK hospital aspect because of the savings?

By asking that question, you are admitting you have no idea what you are commenting on…

My wife did two nights with the first and one night with the second. No point holding up beds for no reason. Leave them for peeps who had complications or had a sickly child.

Just because you have a baby, does not give you the right to hog hospital beds and resources just because you feel like it.

You definitely need more than 24 hours to establish the breastfeeding side of things for the first baby. Subsequent babies you may want to go early, but possibly not if things went awry previously. There should be more care about who gets sent home within 24 hours. My understanding about the UK scheme s that there are lots of follow up home visits by midwives after the mother goes home. Do Canberra mums get these, or are we simply applying the UK hospital aspect because of the savings?

When it comes to length of stay, all else being equal, you can’t discount whether it’s baby number one or not either. My wife, and so many other friends and acquaintances I’ve heard stories from talk about how much easier it was the 2nd time – both physically and mentally. Their bodies are better prepared, they’re more mentally prepared, and less stressed in general.

I think if you looked at first time mums, most wouldn’t be ready to leave after 24 hours – but most 2nd time mums would be. All assuming no other complications or issues of course.

sepi said :

In private hospitals they keep you for 3 nights as it takes 3 days to establish breastfeeding.

Lucky you! It took me six months. Obviously it would have been completely stupid for me to spend 6 months in hospital dealing with it which is why I went home and got daily help from my midwife for the first few days plus plenty of support from friends and family (ABA also has great resources for ongoing help.)

BTW I’m sorry your baby got sick. That must have been terrifying. They say most immediate problems appear within about 6 hours which is why they do require at least a few hours of observation between birth and discharge. Generally mum needs a good rest anyway, and bub will need to be fed immediately after birth and then maybe again after mum’s had a long sleep, so for many families, there’s not much waiting in hospital, because bub gets the all-clear well before mum’s ready to even stand up.

With the midwife programme you can relax at home and make sure the cat’s also doing OK once the danger period has passed while knowing that help is just a phone call away. Obviously it’s not as safe as being in a hospital but we don’t all live in a hospital, so it’s a question of how long to observe a baby before pronouncing it healthy. This will vary, but the Birth Centre currently discharges as soon as 4 hours after birth if APGAR scores are excellent. They have the option to keep you if your baby starts out well but looks like it might deteriorate.

Madam Cholet1:28 pm 30 Nov 13

I had my son five years ago too – at John James, which has a four night standard stay for normal deliveries. We had a prolonged delivery, but all was well in the wash up. Whilst I was kicking back reading the paper by day 4 and baby was being all very good, the first two days were a bit of a fog and it took probably 24 hours to get the feeding thing going according to plan. I recall seeing women who could not move without wincing and who would have struggled with just an overnighter. You also need to have care available once you go home. It would not be good enough to get left at home to manage alone.

So whilst as someone (who I believe is not yet a parent although memory could be wrong there), posted previously, it is not cancer, it’s each to their own.

In private hospitals they keep you for 3 nights as it takes 3 days to establish breastfeeding.

Not everyone has a fabulous easy birth and hops up for some coffee and toast soon after.

My first baby became critically ill during her first night, after being fine at birth, and needed resucitating twice, so I’m not a fan of making it the norm to go home after 24 hours. If people want to , then fine, but it should’ be expected.

Not everyone is a martyr/superwoman type person who has a baby and is back to normal routines only hours later.

Add me to the vote for the 24 hours thing. I had my son 5 years ago, through the midwife program at the Canberra hospital. I hoped to be in and out within 6 or so hours – well, he didn’t co-operate.

It ended up in a theater delivery and an overnight stay at the hospital. But, it was an uncomplicated delivery (apart from the whole theatre thing), and son and I were both doing well. He was born at 4.35 pm, we managed to leave at about 11 am the next day.

We didn’t need to stay – I was healthy, my son was healthy (and had been checked by all the pediatricians) – why not encourage families to go home?

JimCharles said :

If she’s ill, she won’t be kicked out of hospital.
Just like a lot of operations where a patient used to lie in bed for a week in the thought that they were “recovering”, it now fosters a better recovery by getting a patient up and moving around as soon as possible, whether that be a hip replacement or giving birth.
If patients need to rest they don’t have to be in a hospital bed. And to be honest, why would they want to be when they could be at home ?

Troo fax, the day after the surgeons pinned my femur back together it was decided to get me up on my feet. There wasn’t a professional physio/rehabilitation specialist there that day so I think I ended up scaring the crap out of the poor nurse they’d sent to get me up and about. I was fairly resistant to the idea as I didn’t think you could walk around on a bone that less than one day ago was broken in half but apparently, with a lot of pain, yelling and swearing, you can. Didn’t make a proper go of it ’til the next day though, which didn’t go nearly as bad.

My wife recently had a bub and got discharged 27 hours later. Now when I say discharged she was discharged to what they call midcall, so technically mother and baby are still hospital patients and get daily visits by a midwife for a week. Next day the midcall midwife, came, as she did for a few days. After about 3 days the midwife was concerned for the baby in relation to feeding and back to the hospital the wife and baby went for 3 nights.

Now my set in her ways mother was carrying on like a pork chop that she shouldn’t have been discharged so soon, but frankly I agree with it and reckon the system worked very well in my wifes case.

Now clearly everyone is different, I notice one lady above complaining, but in the same breath saying she stayed for 4 days. Again to me the system worked, you got the care you needed and to a certain extent it is the mothers choice.

JazzyJess said :

BimboGeek said :

housebound said :

This maternity unit was planned from the start to discharge new mums within 24 hours of giving birth. There was a lot of unhappiness with the plans at the time, but the powers that be weren’t interested. No wonder the care model is being criticised now, and no wonder Katy is defending it.

What are you planning on doing for 24 hours? Push out bub, push out placenta, feed bub, have a nap, and if everyone’s well, you’re gonna get really bored after that, sitting around like you’re sick when there’s nothing wrong with you.

Ummm. You’re kidding right? Yes, some new mums are probably fine to go home after 24 hrs. but many aren’t. I was a mess, literally and figuratively, after having my son. I stayed for four days at Woden public hospital before the midwives managed to extricate me. It should be the mother’s choice when to leave.

If she’s ill, she won’t be kicked out of hospital.
Just like a lot of operations where a patient used to lie in bed for a week in the thought that they were “recovering”, it now fosters a better recovery by getting a patient up and moving around as soon as possible, whether that be a hip replacement or giving birth.
If patients need to rest they don’t have to be in a hospital bed. And to be honest, why would they want to be when they could be at home ?

24 hrs might be ok for some, but not as a benchmark. we stayed in [qbyn – excelllent!] for three or four days with no.1 to ensure attachment was ok and we were all settled; then a lesser time with no.2, but still more than 24 hrs.

a mechanistic approach to the non-mechanistic process of birth is irresponsible policy.

poetix said :

24 hours sounds a bit brutal, but some women might prefer that. I just worry about whether there is a real choice in the public system.

I’ve birthed babies in both systems and it’s all a bit of samo samo however, I do prefer public.

I asked my Dr if he thought I should go private or public. He said the difference was that the carpet and the curtains are nicer in private, he was pretty much spot on. Oh and the food – nicer in private. Do they still give you wine in private?

After my experiences, I prefer the care provided in public.

In my experience in private hospital, when something is going weird or wrong, it took longer for the specialists to arrive. However, in public they pushed a button and made a call and I had the best private OB money could buy at my child’s birth for free. Awesome 🙂

Machines that “go ping” are also handy. In the public hospital the machines that go ping worked and there were lots of them, not so much in the private hospital.

EvanJames said :

Hospital care is stunningly expensive. If there’s no medical need for someone to be consuming that stunningly expensive care, then the medically trained people will make that call and send you on your way. While being waited on hand and foot is nice, it’s not an entitlement.

Having babies is a choice, not a sentence. It’s not cancer.

Actually, when my mother in law had cancer, she was sent home earlier than she wanted, too. She was enjoying the rest and was still very tired and intimidated about the idea that she had a lot more work to do when she went home, but they knew she had a supportive husband, that his sister was very close and generous, that her kids and their partners had been in and brought lots of fruit, flowers and books, and spent lots of time with her, and they knew she didn’t need 24 hour observation, just checkups, and that she could easily come in for those.

JazzyJess said :

Ummm. You’re kidding right? Yes, some new mums are probably fine to go home after 24 hrs. but many aren’t. I was a mess, literally and figuratively, after having my son. I stayed for four days at Woden public hospital before the midwives managed to extricate me. It should be the mother’s choice when to leave.

Hospital care is stunningly expensive. If there’s no medical need for someone to be consuming that stunningly expensive care, then the medically trained people will make that call and send you on your way. While being waited on hand and foot is nice, it’s not an entitlement.

Having babies is a choice, not a sentence. It’s not cancer.

I’m all for mum’s and their partners having the choice. If you feel ready to leave, great, if not, then stay until you’re ready. I must say I felt pressured to go before I was ready. That said I would have stayed for a month if they’d let me.

24 hour (or less) discharge is for well women, not every woman. And you can ask to stay longer, and they can’t “kick you out”. But really, if mum is well and hub is well who would want to stay in a filthy hospital, as nice as the new birthing rooms are. In canberra we are lucky to have midcall midwives who visit in the home for a week, and longer if you need it. Giving birth is the most natural thing in the world, stop medicalising it. Bring on stand alone birth centre’s Katy, and then publicly funded home birth to reduce your costs.

I enjoyed the week in hospital after a totally unnatural birth.

24 hours sounds a bit brutal, but some women might prefer that. I just worry about whether there is a real choice in the public system.

BimboGeek said :

Watson said :

Have you ever looked after a newborn 24/7? Or given birth? I gathered not…

It took abot 3 hours and we were home about 7 hours later, after a feed, a nap and making sure we knew how to do a bunch of stuff like change her first nappy, wrap her up, and then I also hung around and had a bit of toast and some coffee.

JazzyJess said :

Ummm. You’re kidding right? Yes, some new mums are probably fine to go home after 24 hrs. but many aren’t. I was a mess, literally and figuratively, after having my son. I stayed for four days at Woden public hospital before the midwives managed to extricate me. It should be the mother’s choice when to leave.

Well then wouldn’t you rather the majority (people like me who had easy births) get out of the way so that beds remain free for people like you who are injured and unwell to recover?

Personally, I can’t see how anyone who has an uncomplicated birth needs to be hanging around wasting resources when there are people who need that care.

+2

Watson said :

Have you ever looked after a newborn 24/7? Or given birth? I gathered not…

It took abot 3 hours and we were home about 7 hours later, after a feed, a nap and making sure we knew how to do a bunch of stuff like change her first nappy, wrap her up, and then I also hung around and had a bit of toast and some coffee.

JazzyJess said :

Ummm. You’re kidding right? Yes, some new mums are probably fine to go home after 24 hrs. but many aren’t. I was a mess, literally and figuratively, after having my son. I stayed for four days at Woden public hospital before the midwives managed to extricate me. It should be the mother’s choice when to leave.

Well then wouldn’t you rather the majority (people like me who had easy births) get out of the way so that beds remain free for people like you who are injured and unwell to recover?

Personally, I can’t see how anyone who has an uncomplicated birth needs to be hanging around wasting resources when there are people who need that care.

I guess if they let people stay as long as they wanted, some would never leave. I’m sure if there are real issues they would let you stay. I think going home and then having a midwife visit is a great idea, and frees up the hospital space for other mothers.

BimboGeek said :

housebound said :

This maternity unit was planned from the start to discharge new mums within 24 hours of giving birth. There was a lot of unhappiness with the plans at the time, but the powers that be weren’t interested. No wonder the care model is being criticised now, and no wonder Katy is defending it.

What are you planning on doing for 24 hours? Push out bub, push out placenta, feed bub, have a nap, and if everyone’s well, you’re gonna get really bored after that, sitting around like you’re sick when there’s nothing wrong with you.

Have you ever looked after a newborn 24/7? Or given birth? I gathered not…

Having been through the hospital recently I’d say it is brilliant. The wife got fantastic care and having the same midwife made a big difference. For baby number one we had to stay at calvary for four days for no apparent reason but we were out of the centenary hospital in 24 hours with baby number two and everyone was just fine.

If the two little buggers I’ve got start behaving and let me get some sleep then I might consider having a third and it will definitely be at the centenary hospital.

Katy touched it. It’s stuffed.

BimboGeek said :

housebound said :

This maternity unit was planned from the start to discharge new mums within 24 hours of giving birth. There was a lot of unhappiness with the plans at the time, but the powers that be weren’t interested. No wonder the care model is being criticised now, and no wonder Katy is defending it.

What are you planning on doing for 24 hours? Push out bub, push out placenta, feed bub, have a nap, and if everyone’s well, you’re gonna get really bored after that, sitting around like you’re sick when there’s nothing wrong with you.

Ummm. You’re kidding right? Yes, some new mums are probably fine to go home after 24 hrs. but many aren’t. I was a mess, literally and figuratively, after having my son. I stayed for four days at Woden public hospital before the midwives managed to extricate me. It should be the mother’s choice when to leave.

housebound said :

This maternity unit was planned from the start to discharge new mums within 24 hours of giving birth. There was a lot of unhappiness with the plans at the time, but the powers that be weren’t interested. No wonder the care model is being criticised now, and no wonder Katy is defending it.

What are you planning on doing for 24 hours? Push out bub, push out placenta, feed bub, have a nap, and if everyone’s well, you’re gonna get really bored after that, sitting around like you’re sick when there’s nothing wrong with you.

This maternity unit was planned from the start to discharge new mums within 24 hours of giving birth. There was a lot of unhappiness with the plans at the time, but the powers that be weren’t interested. No wonder the care model is being criticised now, and no wonder Katy is defending it.

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