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60 Focusing on the mother/baby dyad: let’s aim for healthy mothers as well as healthy babies
  1. Sally Cusack
  1. PBB Media, Byron Bay, Australia


More than 300,000 babies are born each year in Australia and the average age of first time mothers has been increasing over recent decades (the average now being 28 years). The average weight of mothers has also increased.

In the same period the amount of tests and treatments in standard maternity care has increased, which could in part be in response to these changes in the populations of birthing parents.

This increase in testing and monitoring could lead to the impression that outcomes are improving, however, the stillbirth rate has not been reduced, and women are undergoing more procedures. The rates of mothers’ severe anxiety prior to birth and anxiety/depression, even PTSD, after birth are increasing.

There is a particular caution surrounding maternity care, with everyone involved keen to see a healthy baby at the end of the birth process, most of all the parents. This concern can lead clinicians to dismiss parents’ rights to refuse - or request - the care of their choice, in the name of hospital protocol.

However a physically healthy baby also needs a physically and emotionally healthy mother to provide the years of dedicated nurturance after the birth. The health status of mothers with postnatal depression (PNDA) and PTSD has a direct impact on the short and long-term outcomes for the baby.

So, ‘at least you have a healthy baby’ is leaving out a vital piece for the health of the baby - a healthy mother as well.

This presentation will explore the standard procedures that have been introduced over the past two decades and the evidence base for their introduction. I will also discuss the rates of PNDA/PTSD and will conclude with the factors that are most likely to deliver the healthy baby AND mother, and how many of those factors are provided to pregnant Australian mothers in standard maternity care.

Objectives The rates of intervention in maternity care have increased significantly in the past two decades, yet we are not seeing a corresponding decrease in the stillbirth rate, or a decrease in the PNDA rates.

The objective of this presentation is to raise awareness of this increase in interventions in maternity care and the evidence base for introducing these interventions. This data will be set against the backdrop of no decrease to the stillbirth rate, and potential unnecessary damage caused to mothers.

The final objective will be to outline the factors that have been found internationally to improve maternity outcomes, and how many of these factors are included in our maternity system.

Method I will be using Australian and overseas birthing, hospital and available postnatal data, and will cover the history and evidence behind the interventions introduced in the past two decades.

Results The results from my presentation will demonstrate a need to ensure proper processes are in place for reviewing the introduction of new interventions, providing the models of care (ie continuity of care) that allow women to make informed decisions and providing clear guidance to staff of parents’ human rights in birth and how to inform them of their choices without coercion.

Conclusions Continuity of care in maternity services plays a more important role for improving maternity outcomes over increasing screening, tests and interventions in fragmented care settings.

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