Unnecessary caesarean section

This article came from the Australian.
MIDWIVES have warned there are high rates of "unnecessary repeat caesarean sections" in Australia to support a new push for Medicare to pay midwives.They are calling for a national policy to reduce or stabilise the rate of c-sections in Australia within five years and calling for private hospitals and health funds, which have much higher rates of intervention than public hospitals, to join the campaign.The reform push is a strong theme of submissions to a major review of maternity services in Australia being conducted by the Rudd Government, that also suggests post-natal care is letting down new mothers and more support is needed to help women breasfeed their babies.Midwives have also blamed the media for the rise of the "too posh to push" myth and promoting c-sections as a "lifestyle choice" and promoting the "false" notion that a caesarean section is as safe, or safer than, a normal birth.Citing research that suggests 60 to 80 per cent of women with a previous caesarean birth can give birth vaginally, midwives have warned just 16 per cent of women have a vaginal birth after an earlier c-section.But obstetricians have sounded a word of caution on a small but growing number of women who want to give birth at home and suggested one reason for increasing c-section rates is older and overweight mothers.dont you just love how the obstetricians blame the women for the increasing rate of section. It couldn't be anything to do with their practice. What a bunch of misogynists they are.Health Minister Nicola Roxon has today released over 900 submissions to the Rudd Government's Maternity Services Review including hundreds of submissions from Australian mothers on how to improve birth services in hospitals and at home."The majority are from individual consumers. Their personal accounts of experiences with maternity care sound a strong note of concern that our maternity system has become too focussed on medical intervention ,'' Ms Roxon said.Listen up Docs, the consumers are not happy, woman are getting the picture that the maternity system is focused on the medicalisation and not the woman her body and her baby.A key recommendation of the review is expected to be an expanded role for midwives, including Medicare item numbers, which may allow them to commission blood tests or even ultrasounds without requiring clearance from a doctor.There is an international definition of a midwife. Our role doesn't need to be expanded just accepted. Fancy commissioning a blood test or ultrasound, next we will be wanting the vote.Another suggestion is that Medicare should pay midwives, not just doctors, to care for pregnant women to reduce rising caesarean rates in Australia and private health insurance should even cover independent midwives to care for women who want to birth at home.The Australian College of Midwives has raised concerns about rising caesarean rates and other interventions in labour including forceps and vacuum deliveries noting research that just one in five low risk women who birthed in a private hospital acheived a vaginal birth without intervention compared with 39 per cent of public patients."Social induction, which takes place when women are 'sick of being pregnant' is also too common. The flow on costs for the widespread use of interventions in labour are high - both for women and their babies who are exposed to the the risks of major surgery and recovering from it,'' the submission states.What about the social inductions that take place because the Ob has the weekend off?, Or is going on holiday and hasn't bothered to mention to the client before that at her actual due date that he will be away. This is far more common that the "sick of being pregnant" I'm sure that any woman told the risk of induction would really think twice about it.But care for mothers after birth has also emerged as problem in the submissions with The Royal Australian and New Zealand College of Obstetricians and Gynaecologists suggesting this is one area where midwives could play and important role.Righteo this sounds like hard work, lets get the midwives to follow it up, after all we have been paid a massive amount of money to provide continuity of care. Doctors, midwives and breastfeeding experts should be offered direct Medicare funding to improve postnatal care in Australia to boost breastfeeding rates and reduce post-natal depression according to the nation's obstetricians.How about you don't fuck up the birth process, that would significantly decrease the post natal depression rates. Once again the Obstetricians couldn't possibly accept that it may be down to them in the first place. We know in nature that a hindered birth causes the mother to reject the baby. What makes us so very different is we internalise the process onto ourselves as we can't just reject our off spring, and of course don't want to."Inadequacies in post-natal care is a constant finding of all reviews of maternity services. Direct Medicare funding of all practitioners midwives, GPs lactation consultants, psychologists/psychiatrists should be introduced,'' the RANZCOG submission states.But obstetricians have also sounded a note of caution of rushing down the independent midwife path."Suggestions that independent midwives might care for women antenatally and in labour in the public system but as "effective private midifery patients is not supported,'' obstretricians said, citing "interprofessional conduct.Lets never give women informed choice, it would be very bad for our pockets.The Australian Institute of Health and Welfare’s Report "Australia’s Mothers and Babies 2006" released today confirms caesarean section births increased to 30.8 per cent in 2006 compared to the 2004 OECD average of 22 per cent of births.However, the rate is even higher at private hospitals.Dear readerBut it's not the surgeons fault!!! those shifty women and independent midwives are causing so much trouble. Interfering with our schedules, demanding what they want, expecting us to cater for their needs. It's just not on. We are the experts here, we need to be revered. We only earn so much money because we are important. Women's bodies and vagina's are so dodgy that without us they are nothing.Love the Obs.Lets hope that Nicola Roxon and the government are looking at the figures and listening to the women and not being lobbied by the AMA

Writer: Lisa Barret (Midwife-Australia)

Jumlah kasus untuk lahan pendidikan berkurang

Topik diskusi kali ini adalah: 'Bagaimana mencari solusi terhadap berkurangnya kasus untuk pendidikan Obgin".

Seperti telah diketahui saat ini ada 5 RS yang digunakan sebagai tempat pendidikan yaitu RS Sanglah, RSUD Singaraja, RSUD Saniwani Gianyar, RSUD Karangasem dan RSUD Jembrana. Serta 2 rumah sakit luar Bali yaitu RSUD Waikabubak, RS.Bajawa. Sebelumnya ada RS Mataram-Lombok namun sementara dihentikan.

Bagaimana pendapat dan masukan untuk mengatasi masalah ini?

Pendidikan OBGIN di Era Kapitalisme

Pendidikan dokter apalagi untuk menjadi dokter OBGIN kini sangat mahal.

Inikah konsekuensi dari kehidupan di era kapitalisme?

Kini the role of the dedication telah dirubah oleh nilai-nilai ekonomi menjadi the role of the business.

Tanpa terkecuali. Termasuk dunia pendidikan dokter OBGIN.

Apa akibatnya jika kapitalisme menjadi mazab yang dianut dalam ranah pendidikan OBGIN ini?

Konsekuensinya: "Bayar 1 dapat 1000". Atau bayar 1000 dapat sejuta, dan jika bayar sejuta mau dapatnya semiliarkah? Berapakah biaya yang harus dikeluarkan seorang calon dokter OBGIN saat ini? Dan berapa kemudian bayaran yang diminta setelah menjadi dokter OBGIN?

Mari berdiskusi di forum ini. Tata caranya: diskusi ini terbuka untuk siapapun. Dan diharapkan berpartisipasi dengan memberikan masukan untuk menuntun OBGIN melalui era kapitalisme ini dengan selamat dan berbudi.

Salam

Hariyasa Sanjaya

Moderator

Selamat datang di Obgyn Education Forum

Dunia pendidikan adalah dunia yang penuh dengan pergolakan pemikiran. Dan penuh dengan interaksi konsep,keyakinan, perasaan dan realitas.

Dunia pendidikan kedokteran, lebih fokus lagi Obgin memiliki karakteristik yang unik yang menyangkut dua jiwa (maternal-fetal).

Interaksi berbagai variabel menentukan dalam keberhasilan program pendidikan obgin. SDM (staf pengajar, peserta didik yaitu residen, dokter muda, mahasiswa kedokteran (KKR), siswa bidan (S0-diploma).

Berbagai persoalan muncul dari sumber daya, sistem pendidikan, komitmen, inovasi dan manajerial sering kita temui.

Munculnya kekhawatiran akan gelombang besar kapitalisme, materialisme dan hedonisme akan dapat berpengaruh lebih menakutkan terhadap kemungkinan dekadensi nilai dan motivasi dan arah pendidikan obgin.

Sudah menjadi suatu kenyataan dan sangat kuat image serta stigma yang ada bahwa untuk menjadi dokter spesialis obgin memerlukan biaya yang sangat mahal. Realitas ini menunjukkan bahwa pendidikan obgin memang telah berada pada jalur "industri pendidikan" dengan paham kapitalistik, investasi yang padat modal dan memaksa para pesertanya menggunakan hukum dagang.

Ini akan menimbulkan konsekuensi komersialisasi.

Wajah pendidikan kita mungkin akan menjadi permisif dan pragmatis. Bukan puritan yang idialistik.

Terjadi perubahan yang sangat mengkhawatirkan dalam realitas "industri kesehatan" dimana tuntutan hukum terhadap para dokter tak terkecuali dokter obgin, semakin memperkuat desakan dan kontraksi pergeseran dan perubahan nilai para dokter untuk lebih memproteksi dan cenderung menjaga jarak dengan pasien. Ini pula yang kemudian menimbulkan dampak peningkatan biaya dalam pelayanan medis.

Dekadensi yang terjadi pada prilaku para dokter akan menyeret nilai dan citra dokter termasuk dokter obgin.

Diperlukan suatu upaya untuk tetap menjaga benteng idialisme pada peserta didik (residen, dokter muda, mahasiswa kedokteran) dan terutama para dokter obgin sendiri.

Jangan sampai banyak dokter obgin masuk ke hotel prodeo karena pelanggaran-pelanggaran hukum yang disebabkan lunturnya nilai-nilai luhur yang mesti dimiliki oleh seorang dokter obgin.

Forum ini bertujuan untuk membuat wahana untuk berinteraksi dan saling menguatkan dalam menjaga pilar-pilar keluhuran profesi dokter obgin. Saling berbagi motivasi dan inovasi dalam mengembangkan sistem dan proses pendidikan obgin yang berkesinambungan dan terus menerus.

Mari bergabung dan berinteraksi.

Salam

Hariyasa Sanjaya