A recent court case has reignited discourse on continuity of care in obstetrics.
Results of a Victorian court case have prompted the maternity sector to reiterate the importance of continuity of care.
A Victorian woman was awarded $280,000 by the Supreme Court of Victoria, after a judge ruled that she did not properly consent to having a vaginal examination during labour.
The patient’s birth plan detailed that she declined to all vaginal examinations unless medically urgent due to past trauma.
But when she presented at Bendigo Hospital maternity with contractions, nursing staff refused to contact the patient’s usual midwife or admit her until a vaginal examination was completed.
The maternity sector has responded strongly to this mishandling, arguing that this emphasises the value of continuity of care.
“We know from all the studies that what women value in maternity care is having continuity of carer,” former president of the National Association of Specialist Obstetricians & Gynaecologists (NASOG) Associate Professor Gino Pecoraro told The Medical Republic.
“Which means that they see the same person that they know and trust during the pregnancy stage, during the delivery stage and afterwards.
“When you can achieve that, there are the best outcomes for women, and they report the highest rates of satisfaction.”
NASOG QLD Councillor Dr Kellie Tathem said that the case could trigger “significant downstream effects for the broader health system.”
Fears that this case could deter clinicians from entering the profession have also been made clear by Dr Tathem, who said that these errors must be avoided as part of effective practice.
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Clarification on the importance of vaginal examinations has also been issued, detailing how this sensitive practice should be issued with contextual consideration to ensure patient comfort.
“This right to autonomy must be supported by access to expertise,” Dr Tathem said in a NASOG press release.
“Without this, the burden of decision-making in labour can fall heavily on women at a time when clinical nuance and rapid change are common.
“To understand this balance, it is important to consider why vaginal examinations are recommended in labour.
“It is a clinical judgement that sits within the broader context of a woman’s pregnancy, her risk factors and her birth plan.
“These factors are best understood when there has been continuity of care with a coordinated maternity team, including GPs, midwives and specialist obstetricians.”
Models of care that prioritise continuity, Professor Pecoraro said, are the best approach to resolve the wider issue, providing support to better coordinate maternity care throughout pregnancy not just at crisis points.
“The best way to give people the best chance is for women to be seen by a team of midwives and also people like anaesthetists and paediatricians,” Professor Pecoraro told TMR.
“So that you have a chance to talk about what happens if things don’t go according to the preference sheet.”
