Warning on maternity care plan

"We don't believe this is the safest option, and it contradicts NSW Health policy." - Drew Barr
“We don’t believe this is the safest option, and it contradicts NSW Health policy.” – Drew Barr

Nurses point to potential health risks to mothers and newborns.A plan to partially restore maternity services at Pambula Hospital may jeopardise the health of mothers and babies, nurses warn.The 30-bed hospital on the New South Wales far south coast comprises an emergency department, operating theatre and general ward that also provides palliative care services.

It was marked for closure by the previous state government and lost its obstetrics service in 2008. Maternity services were centralised at Bega Hospital 35 kilometres away.

The current state government has promised to keep Pambula Hospital open, and Southern NSW Local Health District (LHD) management want to introduce a post-natal service there.

While the local community has welcomed the news, the Pambula branch of the NSWNMA warns the proposal may be risky because it attempts to offer a partial maternity service with one-hour-per-day midwifery support.

Two post-natal beds are to be designated at Pambula Hospital. New mothers who live in and around Pambula will be discharged from Bega Hospital following birth and must make their own way to Pambula Hospital for readmission to the general ward.

Drew Barr, president of the Pambula branch of the NSWNMA, said LHD management did not intend to employ any midwives at the hospital to support this new service.

Instead, community midwives will visit inpatients for about an hour per day leaving nurses, rostered to care for patients on the general ward, responsible for providing midwifery-based care for the other 23 hours.

“We don’t believe this is the safest option, and it contradicts the NSW Health policy Maternity – Towards a Normal Birth in NSW,” Drew said.

“Birthing women deserve to be looked after by qualified midwives who are an integral part of antenatal, intrapartum and post-natal care.

“Pambula Hospital nurses welcome a return of maternity services, but we are wary of this plan because it may not be the best way of providing safe patient care.

“The proposal could be improved either by employing a midwife on each shift at Pambula Hospital, as was done before maternity services were removed, or employing more midwives in the domiciliary midwives program, so birthing women in the Bega Valley can be discharged home from Bega and adequately supplied with skilled midwifery care during their post-natal period.

“If a new mother is well enough to be discharged from Bega Hospital she should be well enough to go home to a properly funded and fully supported domiciliary outreach program.”

Drew said that under the proposed plan, if post-natal or neonatal problems arose outside the domiciliary midwife’s scheduled one-hour-per-day visit, the patient would be transferred, by ambulance, back to Bega Hospital.

He said the LHD could be misleading the community by presenting its plan as a restoration of maternity services at Pambula Hospital.

“Mothers and babies discharged from Bega Hospital will be admitted to Pambula Hospital under the VMO (visiting medical officer) of the day. Apparently they will be classified as social or respite admissions not maternity patients.

“Pambula Hospital no longer has a nursery area or baby bath or change facilities, even for the public, so there will be nowhere to bath a baby except in the plastic neonatal cot. The proposal may not include dedicated maternity beds.

“The nurses are concerned that, while health and hygiene standards at Pambula Hospital are excellent, risks to the newborn infant in this proposal remain unknown.”

Drew said that, under the LHD plan, maternity patients discharged from Bega Hospital and sent to Pambula would be new admissions not transfers, so NSW Health would not have to provide transport.

“New mothers will have to use their own vehicles on the 30-minute drive to Pambula on the busy Princes Highway, at their own risk, because of the proposal to discharge and re-admit rather than transfer with a midwifery escort.”

The state government recently promised that Pambula Hospital would remain open after the new $170m South East Regional Hospital opens at Bega in 2016.

The Pambula Hospital catchment contains about 20,000 residents, forecast to rise to 28,000 by 2030. About 25,000 tourists visit the region over the Christmas-New Year period until Australia Day.