Title: Model Birthing Unit for Wyong
Wyong Hospital’s maternity unit has seen ups and downs in its 13-year history, but is now back on the rise again as the Central Coast’s low-risk birthing centre.
As the venue for almost 10 per cent of births for the Central Coast, Wyong’s birthing unit has a way to go before competing with the number of babies born at Gosford Hospital, but Central Coast Health’s Acting Divisional Manager for Women’s, Children’s and Family Health Angela Monger hopes that day is closer.
“We support births locally for people. People want that. If we could get more of our normal births out to what is now essentially a birth centre [at Wyong Hospital], then we would lighten the load at Gosford and we normalise birth for women,” Ms Monger said.
The unit opened in October 1997, however problems such as a lack of obstetricians and anaesthetists and funding for registrars and trainees, have meant it has closed several times, including a five-month closure in 2008. “In early 2008 we had a problem with lack of obstetricians here at Gosford so there really was no choice. The obstetric support that was at Wyong was brought to Gosford,” she explained.
Then started a recruitment program for obstetricians that is still underway even now. “It was obvious we weren’t going to be able to fix the lack of obstetricians problem here quickly so we went into recruitment. Most of our applicants were from overseas and it takes a considerable amount of time to get them over here,” she said.
When the Wyong birthing unit re-opened in late 2008 it was under two midwifery care models – caseload or Midwifery Group Practice (MGP) and Team Midwifery Program (TMP) – and run independently from Gosford Hospital. Women who needed obstetric support or had problems in labour had to go to Gosford Hospital.
“With caseload a woman is allocated to a known midwife and, apart from when the midwife is on her designated days off, that is the midwife that they see for all their visits, in labour, and all being well, that’s the midwife who will care for them. Women going through caseload feel more supported and more secure and able to continue with their decision to have their baby at Wyong. We want to continue to have more babies at Wyong,” Ms Monger said.
And this is the scenario Central Coast Health is aiming for. “We also know we get better outcomes from normal women when they are away from an environment of a high risk birthing unit,” Ms Monger explained, saying fear caused longer labours and greater pain. “Women who feel completely supported and capable of doing something actually manage to do it so much better. Women being supported by an individual who is very experienced and philosophically of the viewpoint that birth is a natural process are going to have better outcomes.”
The process of going to hospital to have a baby and then returning home soon after is called Domino Domiciliary in the United Kingdom, where Ms Monger practised as a midwife. Care is provided in a woman’s home by midwives post-natally and, sometimes, ante-natally.
Despite recruiting midwives for the TMP model, the number needed to effectively staff Wyong birthing unit could not be maintained and Ms Monger decided to switch to one care model, similar to the system run at Belmont Hospital. “Belmont has operated successfully like that for a considerable amount of time now and has very good outcomes - very short lengths of stay and women who are supported by their midwives to go home early then have whatever home visits are necessary for the individual.”
So now women attending Wyong Hospital to give birth naturally can see the midwife they had seen throughout their pregnancy and a second midwife comes in for support as the baby is born. The unit is sometimes heaving with activity, and other times quiet. “We always say our birthing suite is a bit like the emergency department of the hospital – we can’t predict exactly what is coming in,” Ms Monger said, and added there was some known activity like booked inductions and caesareans, “but we can’t control when people will go into labour”.
Another advantage of the MGP model is allowing midwives to stay with labouring women if they have to be transferred to Gosford, even if they only stay with her as a support person. This model also provides assessment during pregnancy, such as if a woman has had some bleeding or they think their baby is not moving.
“Our hope and intention is that one day we will have all the required resources for reintroducing an obstetric service at Wyong,” Ms Monger explained and added she hoped home birth would also be an option for Central Coast women. “We’re not able yet to offer people home birth on the Central Coast, but I certainly hope that that is something that will be available to people one day.”
“A birth unit like Wyong is there for people who would have a birth at home – they recognise home as the best place to be, rather than a hospital environment. Hospitals generally don’t perpetuate the whole wellness model – it’s an illness model of care.”