'Close Call' Birth Underlines Need For Pambula Maternity Unit. Australia

Main Category: Pregnancy / Obstetrics
Article Date: 22 Oct 2009 - 12:00 PDT

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The Rural Doctors Association of NSW (RDA NSW) says last week's close call where an ambulance had to divert to Pambula Hospital when the pregnant woman it was carrying went into the final stages of labour is certain to be one of many adverse events following closure of the hospital's maternity unit-and should serve as an urgent warning to the NSW Government that the maternity unit on the state's Far South Coast must be re-opened.

RDA NSW has also strongly refuted comments attributed to the Greater Southern Area Health Service's Director of Medical Services, Dr Joe McGirr, in this week's Merimbula News Weekly that establishing Bega as the maternity centre for the Bega Valley region has been the safest option. RDA NSW has argued instead that the decision to close Pambula Hospital's maternity unit has halved the number of maternity units available to mothers and babies in the Bega Valley Shire and forced 4 out of 6 resident GP obstetricians from the local obstetrics roster.

RDA NSW is also concerned with Dr McGirr's reported comments that expectant mothers should plan so they are able to get to the Bega maternity unit in plenty of time-the Association has warned that sometimes even with the best planning in place some babies will arrive unexpectedly prematurely, and it is Area Health Services themselves that are responsible for providing the appropriate services to cope with these eventualities.

When Kerrie Chester went into unexpected early labour at her home in Eden on NSW's Far South Coast last Thursday night, she attempted to get into her car for the long drive to the now-nearest maternity ward at Bega Hospital, around 50 minutes away. Until it was closed last year, the maternity unit at Pambula Hospital would have been Kerrie's closest unit, reachable within 20 minutes.

When Kerrie had difficulty getting into the car, her mother and partner realised that the birth was imminent and they called an ambulance. Kerrie's waters broke just as the ambulance officers arrived at her house.

The local ambulance crew placed Kerrie on-board and began the journey into Bega, however less than halfway into their trip they realised the baby was about to deliver and they diverted to Pambula Hospital. Fortunately an experienced midwife was on duty despite the maternity unit having been closed by the Greater Southern Area Health Service last year. The baby was delivered safely.

"On the one hand, Kerrie and the Greater Southern Area Health Service were very lucky in that an experienced midwife happened to be on duty at Pambula Hospital on Thursday night-and given the hospital's maternity unit has been closed, there is no requirement for there to be a midwife on duty at any time anymore" RDA NSW President, Dr Ian Kamerman, said.

"But what if there were serious complications with the birth and, due to the closure of Pambula's maternity unit, the hospital was no longer equipped to deal with an obstetric crisis, the available staff were no longer experienced in complicated deliveries or obstetric emergencies, or the appropriate staff were not rostered on?

"What has been a good outcome on this occasion could, in another situation, very easily have been a tragedy.

"This latest event should send a strong warning to the NSW Government and Greater Southern Area Health Service that the people of the NSW Far South Coast urgently need the maternity unit at Pambula Hospital re-opened. To not provide this service is a less safe option and will predictably lead to adverse outcomes to mothers and babies on the Far South Coast. It looks like it will take a serious event, such as the death of a baby or mother, before the NSW Government listens to mothers and local health professionals on this issue.

"After delivering at Pambula Hospital at 12.20am on Friday morning, Kerrie was back in the ambulance within the hour to be transferred to Bega Hospital, as per the current directive from the Greater Southern Area Health Service-this meant allocating an emergency service vehicle for a non-urgent transfer. Soon after arriving at Bega Hospital, Kerrie was placed in a bed in the hospital's surgical recovery ward for around an hour and then in a general ward outside the maternity unit, alongside a labouring mother.

"The question has to be asked as to why, under Greater Southern Area Health Service's directives, healthy mothers and their babies are not able to remain at Pambula Hospital for their postnatal care, and instead are taken up the highway by ambulance in the middle of the night to be placed in a surgical recovery ward at Bega Hospital?

"Kerrie was discharged from Bega Hospital later that morning. Given that the noise level of the ward she had been placed in at Bega Hospital was making it difficult for her to rest, when offered the opportunity to be discharged she did so and returned home.

"It is hard to believe that in this country in the 21st century there was a very real possibility that Kerrie nearly gave birth halfway along the road between Eden and Bega due to the inability of NSW Health to plan for this eventuality.

"We fervently hope this close call will cause the NSW Government and Greater Southern Area Health Service to reassess whether they are really improving the safety of obstetric care in the Bega Valley Shire by halving the number of maternity units in the Shire and forcing two-thirds of the Shire's resident GP obstetricians off the roster …before it is too late."

Source
Rural Doctors Association of Australia