child birth

Burnet Institute’s Healthy Mothers, Healthy Babies is an important collabrative program designed to respond to the unfinished work of addressing the high rate of maternal and newborn deaths in Papua New Guinea.

When women in Australia ponder their pregnancy and the upcoming birth of their child to be, they often think of the joys (and sleepless nights) they’re likely to face. We’re lucky that it’s rare to ever hear of a mother dying in childbirth, and whilst some families do face the horrendous tragedy of stillbirth or newborn death, it’s thankfully uncommon. We’re so fortunate to have excellent prenatal care and ready access to quality and timely healthcare throughout pregnancy and birth. But this is not the case in Papua New Guinea (PNG) where the maternal mortality rate is one of the highest in the world.

PNG is our nearest neighbour and so it is astonishing that the risks facing mothers and their babies there is so profoundly different to those we face here, just a hundred or so kilometres away. Around 1,500 mothers lose their lives as a consequence of pregnancy or childbirth per year in PNG, and more than 5,000 babies die in their first month of life. This is a devastating reality for families in PNG.

The good news is that one of Australia’s leading medical research organisations, the Melbourne-based Burnet Institute is working hard to change this. The Burnet has been working in PNG for close to 20 years. The cornerstone of their work in PNG is Healthy Mothers, Healthy Babies research program (HMHB), which is designed to help women and their babies have the best chance of surviving childbirth and give babies the best start possible to then thrive through childhood.

PNG is our nearest neighbour and so it is astonishing that the risks facing mothers and their babies there is so profoundly different to those we face here, just a hundred or so kilometres away.

There are many factors that contribute to PNG’s very high mortality rates, rugged geography and poor infrastructure, especially in rural and remote areas, can mean access to health care is very difficult. There can be a lack of understanding around the importance of antenatal care with many women attending clinics late in pregnancy or not at all. There can also be small but significant financial constraints on families, which add to the burden of travel or the cost of accessing care, or there could also be the lack of partner support, or a preference for traditional birthing practices within villages.

All these issues can be further complicated by the complexity surrounding common diseases that are often present such as malaria, undiagnosed sexually transmissible infections, tuberculosis as well as malnutrition and high levels of anaemia, all of which can contribute to poor maternal and newborn outcomes.

Healthy Mothers, Healthy Babies is working towards a healthier PNG, focusing on improving outcomes for women and babies in order to save lives. It is a broad research program examining medical causes and behavioural risk factors for poor health, and also looking at social factors influencing health, the provision of health services, and how to encourage effective uptake of services.

Our team of researchers is working alongside local facilities and communities to better understand some of the difficult issues that contribute to poor health outcomes for women and babies in PNG. HMHB is aiming to identify what the main drivers are for poor maternal and newborn health, especially for babies being born too small. Babies born too small, either because they haven’t been able to grow adequately in pregnancy or because they’re born too soon, face a much higher risk of dying in childbirth or early infancy. For those babies who make it through, they face a higher risk of poor growth and development in childhood, often referred to as stunting.

Around 1,500 mothers lose their lives as a consequence of pregnancy or childbirth per year in PNG, and more than 5,000 babies die in their first month of life.

Burnet’s Senior Researcher, Dr Michelle Scoullar, has been working on the Healthy Mothers, Healthy Babies program since 2014, and having lived and worked in Papua New Guinea, understands just how difficult it can be to improve a system that is so complex.

“There are many gaps in our understanding, but through our Healthy Mothers, Healthy Babies program we are already identifying some of the key issues that are impacting on mothers and babies that can be targeted to improve their health,” Dr Scoullar says.

“As part of our first study, we have recruited 700 pregnant women in East New Britain Province and we’re following them from their first antenatal clinic visit, through to their labour, and then also seeing them and their baby at one month, six months and at 12 months.

“At each visit we’re taking a whole series of blood tests and swabs, and growth measurements to identify any issues such as infectious diseases, anaemia, nutritional deficiencies and stunting.”

Photo: Some of Burnet’s Healthy Mothers, Healthy Babies research team including (right to left) Rose Suruka, Lucy Au and Elizabeth Walep together with Sr. Jacklyn Telo.

We’re also interviewing families and healthcare workers identifying barriers to families accessing available health care, and looking at ways to improve the quality of services currently provided, all factors that ultimately influence outcomes for mothers and babies.

One key issue that has arisen from our study is the significant lack of knowledge about family planning.

“Only one in four women interviewed as part of this study had used a modern method of contraception and we’ve found there is a huge demand for these methods of contraception but less than half of the demand is being met,” Dr Scoullar says.

“Supporting women and couples to plan for healthy timing and spacing of births is a cost-effective approach to reducing maternal and infant mortality and has proven benefits not just in preventing death, but also for gender equality, educational attainment and poverty reduction.”

“Were only part-way through the Healthy Mothers, Healthy Babies program and very limited by funding, so any additional support from the Australian or Papua New Guinea community will help us make a huge difference to women and children in Papua New Guinea.”

Dr Michelle Scoullar is a paediatric doctor who is also completing her PhD as part of the Healthy Mothers, Healthy Babies program.

For more information about the Burnet Institute and Healthy Mothers, Healthy Babies or to make a donation go to burnet.edu.au or call (03) 9282 2111

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Choosing where to give birth is one of the biggest decisions you will make during your pregnancy. Whether you are contemplating public or private care, there are several important factors, as well as possible alternatives, to consider when choosing the best maternity care option for you and your family.

Finding out you are going to be a parent is a very exciting time, but making decisions about the right maternity care for you and your new baby can be a bit overwhelming. We take a look at some of the maternity care options available.

Private Care

If you have maternity care included in your private health package, you may wish to choose private care for you and your baby. If you receive care through the private system, you choose a private obstetrician, who will care for you from your antenatal appointments, right through to the birth and postnatal check-up.

Dr Stephen Lane, president of the National Association of Specialist Obstetricians and Gynaecologists (NASOG), says in the private system, the baby is delivered by very experienced caregivers, with obstetricians going through six or more years of specialist training, on top of their five or six-year medical degree.

He says the most common reason many people choose to have a private obstetrician is continuity of care.

Dr Lane says some considerations expectant parents think about when choosing an obstetrician include:

✪ Gender (for some women, choosing a female obstetrician is important)

✪ Location (“Is there a suitable carpark that is accessible? Are the rooms easy to get to? I think these things are important to consider,” says Dr Lane)

✪ The obstetrician’s desk staff (“If the desk staff are friendly and approachable that is a good sign,” Dr Lane says. “It gives a good feel that they are a mirror of the person you will be seeing.”)

✪ Cost (Dr Lane says the majority of obstetricians and gynaecologists in Australia charge well below the Australian Medical Association’s rates, with the average out-of-pocket cost for delivering a baby throughout Australia around $2000).

Note: Ask about your chosen obstetrician’s fee schedule and check with your health cover provider to find out exactly what is covered so you can be prepared for any out-of-pocket expenses.
“Australia is recognised as one of the safest countries in the world to have a baby, and this is a reflection of the world class education our specialist obstetricians and gynaecologists undertake, with many completing more than 12 years of study and training,” he says. “NASOG believes that the care provided by specialist obstetricians and gynaecologists is worth every cent to the patients who enjoy improved health outcomes as a result of our professional care.”

Katie Lavercombe says she chose a private hospital because she wanted to be able to access any pain relief that she wanted during childbirth and was afraid her wishes might not be respected at a public hospital.

“I loved giving birth at a private hospital, the care was great, it was never too busy, and the staff were attentive,” she says. “We loved being able to stay together as a couple and have time to bond with each new baby.”

Katie is currently pregnant with her fourth child and does not have the right level of cover to choose a private hospital this time, so is receiving care through the public system.

“We are utilising the public system, and while it is full of hard working doctors and midwives, there are long wait times at each appointment, meaning a large chunk of my time is taken up by waiting for medical appointments,” she says.

Crystal Henderson decided to have her daughter at a public hospital because her GP recommended it. “We had planned to go Private, but when he recommended it, along with many of our friends, who shared their very positive birth stories after giving birth in public hospitals, we thought we should at least look at it,” she says. “When we went to the public hospital, and they took us through the rooms and birth suites, we were blown away.”

Ms Henderson says she was very happy with the care she received. “There (were) some minor complications during the labour and I needed extra medical assistance, however I felt very safe, in control and informed of everything the whole time,” she says

Shared Antenatal Care

If you have a great relationship with your trusted family GP, then shared antenatal care might be an option to consider. In a nutshell, antenatal shared care involves a woman’s appointments being shared between maternity care providers (usually GPs, midwives and obstetricians), and is most commonly between a GP and maternity staff in a public hospital.

Dr Wendy Burton, chair of The Royal Australian College of General Practitioners’ antenatal/postnatal care specific interest group, says women choose to have shared antenatal care with their GP for a number of reasons.

“They may have a good relationship with their GP and are confident that they will be well taken care of,” she says. “The GP’s rooms may be closer or more convenient than the hospital/obstetrician or GPs may work extended hours, making appointments easier to plan around work commitments.

“Antenatal shared care involves a woman’s appointments being shared between maternity care providers – usually GPs, midwives and obstetricians.”

“The best models of shared antenatal care involve a collaborative team effort with well-informed GPs communicating effectively and efficiently with the other providers of care,” she adds. “If your usual GP is not up-to-date with current best practice for antenatal care, they may be able to recommend another GP who is better placed to provide care for you.

Work is currently underway to create digital records and an app for women, which will give additional options for the sharing of the pregnancy health record.”

Your Support

Who will be your support person when you welcome your baby into the world?

Many women will choose a partner, family member (such as their Mum) or a close friend to be their support person. However, there are some options to consider.

For example, a midwifery student is a good choice. They will attend antenatal appointments with you and, if you consent, can also attend the birth.

Another support option is a doula (a professional, non-medical birth and/or postnatal companion who is able to provide continuity of care, and emotional and physical support during pregnancy, birth and the postpartum period).

Michelle Perkins, chairperson of Australian Doulas, says many women hire a doula after experiencing a negative or traumatic previous birth experience.

“Some hire a doula to help them understand the maternity/obstetric systems. Some hire a doula to provide emotional and physical support if they do not have a partner, or if they believe their partner may also need support and guidance.”

Home Birth

Do you want to have your baby at home?

Grace Sweeney, coordinator at Homebirth Australia, says a woman who chooses to birth at home is guaranteed to receive continuity of care from a known midwife.

Ms Sweeney says the most important thing that a woman considering homebirth needs to do is to seek out a midwife as soon as possible.

“Nearly a decade of a sustained witch hunt against homebirth midwives has meant that midwives in private practice are scarce, and book out early,” she says. “It’s worth doing research on midwives in your area before you’re pregnant and making a booking as soon as your pregnancy is confirmed.”

Dr Lane says NASOG does not support home births in Australia.

Sarah Purvey decided she wanted a homebirth for her first child. “I had two private midwives,” Sarah says, when asked about her care. “A primary midwife came to my house regularly in pregnancy, so I built a very close relationship with her in that time and all the options for tests and injections were managed by her, with my consent and our discussions about them first. My primary midwife was there during the birth and then I had a second midwife attend shortly before my babies were born. For my first birth, I was also supported by a private obstetrician. I saw her a few times during pregnancy and she was open to supporting me, if I needed to transfer to hospital, if I needed more medical support from home.”

She says her experiences were wonderful and empowering.

“My first birth was very tough, long and in the end, I did transfer to the private hospital with my obstetrician, as I had a long second stage. In the end, I had an episiotomy, which couldn’t be done at home. This was handled beautifully by my midwives and by my obstetrician. I spent about 30 minutes continuing to labour in the private hospital, once I arrived, then we all discussed the option to do an episiotomy. I consented and this was done well. I felt wonderful when my baby arrived, despite 18 hours of active labour and a previous night of no labour.”

“Second time was much easier – four hours of active labour and my baby was born in to the water, straight into my arms and onto my chest.”

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