Australian College of Midwives say birth trauma is rife in NSW

The submission accuses both levels of government of not taking swift action to implement their own policies, which could have prevented many women from experiencing birth trauma. It points to a culture of cover-ups, and lack of empathy for women before, during and after giving birth.

It acknowledges the work of NSW Health in creating a blueprint for maternity care, but said the standards are not being met.

"It is evident from this inquiry, and contemporary birth trauma research that this goal is yet to be actualised," it says

"Some midwives disclosed within their responses - in confidence - that there were concerns expressed by some managers around midwives providing submissions to this inquiry. ACM considers that this may be indicative of the current maternity care culture and may reflect the patterns of behaviour that are the focus of this inquiry."

While Australia has one of the lowest birth mortality rates in the world, little has been known about the individual experiences of women giving birth until recently.

Recent studies have shown as many as one in three women experience birth trauma, and one in ten experience obstetric violence during pregnancy or labour.

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ACM's submission to the inquiry includes disturbing testimony from midwives who say they have been themselves traumatised by their experiences in public hospitals.

This has created a vicious cycle similar to the one observed in primary healthcare workers, where midwives leave the profession, and those who remain are left with unmanageable workloads.

This leads to a lower quality of care, and mistakes become inevitable.

One midwife with over 10 years experience in regional NSW said women are not being put at the centre of care - the organisation is.

"I have seen the most abhorrent disrespect and coercion with language, contemptuous attitude, anger, violation of human rights, bullying, threats, refusing and attempting to withdraw care or the right to enter a public hospital," she said.

"Birth trauma and violation of human rights and disrespectful maternity care is prevalent and rife and getting worse.

"Health care practitioners are not feeling safe or supported by legislation or regulatory boards or by organisations to support women and their rights to informed choice and respectful maternity care."

The inquiry into Birth Trauma was prompted by dozens of complaints lodged by the Maternity Consumer Network about birthing trauma experienced at Wagga Base Hospital.

The inquiry has received an "unprecedented" number of submissions with more than 4000 responses received. Most of these have come from individuals, primarily from individual women who have been traumatised by their experience giving birth.

Enquiry chair Emma Hurst said it could take up to six months for most of the submissions to be public.

"Because there are so many individual submissions, we need to make sure we don't retraumatise any individual that comes forward to give evidence," she said.

"There might end up being a lot of in camera hearings, where the committee hears from an individual that made a submission, but that never becomes public..

"That's what's slowing down the publication of the submissions. The resources of the parliament are limited in terms of the speed they can go through that."

So far, about 250 of the 4260 submissions have been made public.

The most recent submissions made public are those from major institutions, including NSW Health, and the Australian College of Midwives.

NSW Health acknowledged the existence of Birth Trauma in their submission, but stopped short of admitting culpability for women's' experiences.

"NSW Health acknowledges women may experience birth trauma, both physical and/or psychological and that birth trauma is individual, and those women who experience birth trauma may experience long lasting effects and these may impact their ability to bond with their baby," they wrote in their submission.

"Evidence around the prevention, identification and treatment of birth trauma is continually informing policy and practice.

"NSW Health has continued to support local health districts to develop and implement innovative models of maternity care that are responsive to the individual needs of women and provide care that matters to women and their families."

The 47-page submission details the policies NSW health have in place to prevent obstetric violence, and improve the quality of maternity care in the state.

A submission by the NSW Nurses and Midwives Association (NSWNMA) disputes these policies are working effectively. It says a "patriarchal medical model" is driving the increases in birth trauma in NSW.

"The relentless subjugation of women in our society combined with paternalistic policies and attitudes that suggest birthing women are incapable of making reasoned and rational decisions has created a culture whereby women are expected to comply with any recommended intervention," it says"

"This expectation is framed around what is best for the baby - prioritising foetal wellbeing ahead of maternal wellbeing.

"Many examples were provided of women being threatened their baby would die if they did not agree to the intervention. Implied or express consent given under extreme duress is not consent."

Submissions lodged by ACM, NSWNMA, and a number of other bodies representing healthcare professionals say there is a need to transition as quickly as possible to a continuity model.

This means women would see the same healthcare professionals before, during and after pregnancy.

The personal relationships and trust that develop through the continuity model are proven to improve the wellbeing of women, families and healthcare workers involved in the birth.

The problem remains despite the best intentions of many healthcare workers, the public health system is not well enough resourced to provide this level of care to every woman.

Ms Hurst said the significant interest in this inquiry means it is likely this will remain a live issue until women and healthcare workers are satisfied.

Murrumbidgee Local Health District and NSW Health say they will cooperate in full with the inquiry.

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