Part 2. Consequences.

After the professor left, the standards at JHH dropped badly in the early 2000’s.

Under his tenure, JHH was the main reason I stayed in Australia and I thought the John Hunter Hospital was the finest Hospital I had ever worked in and I never wanted to leave. After completing my training by doing a fellowship in the UK I returned as a staff specialist in 2006.   I was shocked to find that under the different leadership the outcomes were the worst in Australia.

I pointed out a few home truths, fell out with the new management, was shown the door and went into private practice the next year.

This dark episode- which I can assure people is now well and truly over at JHH - allowed something to establish in Newcastle that I had not seen before- radical midwifery and freebirthers.

I'd seen dopey things before - in Lismore I knew of a baby born at the Protesters Falls, a nearby waterfall and romanticised hippy hang out. While the birth had gone fine the baby was brought in to the hospital hours later with hypothermia and died.

The recent events at JHH made me check out the online presence of the unregulated midwifery services in Newcastle and NSW.

The websites vary in quality as you would expect, To the trained eye many red flags are obvious with the most common thread being that risk is downplayed. This is a common technique to rope in the gullible.

Having done it for over half my life I can assure you Obstetrics is a serious game – when done poorly there are life-changing implications in play for 2 people not just 1.

I’ve been here in Newie for 26 years and I did not recognise the names of any of the local private midwives. Is that relevant? Perhaps it means they are either young or new to the area?

I was drawn to one website which was nicely done and full of good information….Until it tried to give the impression that the midwife and others were working with obstetricians and one of us would ride to the rescue when the wheels fell off. That idea is a lie and quite frankly ridiculous. Why would I?  By the time these people will accept or even recognise that the situation is dire at home it's a very deep hole and the only answer is an ambulance or just as likely you get put in your car to the JHH.

Medico legally we are not allowed anyway by our insurers who would have a fit at the risk of it.

Seen on one of the websites was this quote.

“Woman-centred care is being replaced with fetus-centred care, the mothers experiences are sacrificed to ensure the safe delivery of a healthy baby.”

It's a confronting statement for a caregiver (and perhaps a parent) to see.  Are these people catering for a niche market? Yes

Do we as caregivers need to try harder to make women feel safe in a hospital birth? Yes

I say all this as a big supporter of midwives. I have two amazing midwifes in my practice and many of my patients will have valued the care they have had from them before, during and especially after their births. My second child was safely born at Belmont. I teach student midwifes and encourage the midwives at NPH to improve their skills. I can say without fear of contradiction that there are midwives at NPH that can manage a labour better than 90% of the trainee doctors at JHH that I've seen recently.

So to me the only solution is better education, selection and teamwork for both midwives and doctors to focus on their main priority which is both the mother and baby. We have a midwife at NPH who will soon qualify as a doctor and intends to become an obstetrician. I think she will be excellent and we need more of that rounded training, perhaps that should be a proper pathway into medicine rather than the current fascination with postgraduate entry to medicine. This is just a money spinner for greedy universities who want to drag out the length of training.

I was a doctor at 23 and performing obstetrics at 25. Now at 52 and perhaps at the peak of my powers I feel grateful for all the experience I have gathered in the last 1/4 of a century. It seriously takes that long to master its art.

I'm shocked when I see medical students who will be qualifying in their 40s or even 50s. That’s all very well for GP’s perhaps but its an indulgence from the universities that the surgical specialities cannot afford and I want to see more direct entry places from either high school or the midwifery profession.

The wise old Professor who had picked me up from the train station also said to me "You worry less about the caesarean section rate as you get older". It's true to some degree and I think any parent looking at their children playing in the garden will be giving little thought to how they got here as long as they were safely here.

That being said I remain the obstetrician with the lowest caesarean section rate in Newcastle over the last 20 years. Why? Because I think you fight nature too much at your peril, I don't like unnecessary surgery and I am also a busy gynaecologist. For gynaecology later in life the scarring from a caesarean section makes the operating much riskier and so I do not undertake them without good reason.  All busy gynaecologists know this and therefore they invariably have the lowest ceasar rates. Quiet gynaecologists or pure obstetricians have the highest ceasar rates as the patient is out of sight and mind for them after the birth.

In the next and final part of this trilogy we will explore ways of finding truth and ways of working out those people and institutions that will lie to you.