Maternity Coalition: Australia's national maternity consumer advocacy organization

This chapter tells the story of the Maternity Coalition (MC), an Australian advocacy organization which represents an often ‘forgotten’ strand of the women’s movement — the maternalist feminist emphasis on reclaiming women’s rights in birth and breastfeeding. Having originated in the late 1980s to lobby state government inquiries for improved maternity services in the Australian states of New South Wales and Victoria, by 2008 the organization was established nationally and was acknowledged as a key stakeholder in the incoming federal government’s agenda for improving maternity care. This chapter first examines how the Maternity Coalition developed, its rationale and mothering discourse, and then considers challenges which the organization faces in the early 21st century. Developing from a state-based to a national organization, MC faces internal sustainability difficulties in terms of communicating and managing a voluntary organization mostly comprised of busy young mothers. The external challenges are also considerable—MC aims to change the entrenched system of maternity services but in a cultural context which values technology and professional expertise and a political economic context in which the medical profession holds significant power. Nonetheless, Australia’s Maternity Coalition has achieved a national profile and credibility, bringing women’s rights to options and optimal care in birth to public attention at a level not achieved in many comparable countries

The complexity of social practice : understanding inertia and change in maternity care organizations

Beyond the limited efficiency and economy goals of neoliberal health policy lies the promise of genuine health services reform. In maternity care in particular, recent policy developments have sought to make the management of birth more &lsquo;women-centred and family-friendly&rsquo;. Interprofessional collaboration and greater consumer participation in policy and decision-making are key means to achieve this goal, but changing the entrenched system of medicalised birth remains difficult. Recent social contestation of maternity care has destabilised but not eradicated pervasive medical hegemony. Further reform requires analysis both of institutionalised patterns of power, and attention to the fluidity and situated knowledge shaping organisational and professional practices. Accordingly, this paper outlines a framework with which to explore the multi-layered social processes involved in implementing organisational and cultural change in maternity care. Analysis of social interventions in health systems, we suggest, can be advanced by drawing on strands from critical organization studies, complexity and critical discourse theories and social practice approaches.<br /

Identifying better systems design in Australian maternity care: a boundary critique analysis

This article examines the background and limitations of maternity care policy and provision in Australia using the Boundary Critique method from critical systems thinking. We argue that the historical legacy of funding maternity care within medically dominated fee-for-service structures and acute hospital budgets is seriously flawed. Furthermore, it cannot deliver the policy goals of healthy and socially equitable birth practices. Despite the 2009 national Maternity Services Review and progress of a National Maternity Services Plan (2011), most mainstream Australian maternity services remain out-of-step with both health service research and evidence-based ‘best practice’. The present system drives unnecessary clinical interventions, increased expenditure, short-term adverse health outcomes and the potential for a larger, unacknowledged legacy of future chronic disease. By contrast, boundary critique analysis suggests that redesigning for good maternity service provision can act as a population-level preventative health strategy, offering better value, better health and improved equity in maternity care

Maternity funding and workforce reform: strategies for better design, better value, better health and equity

The purpose of this paper is to make transparent the connections between funding, workforce issues, and clinical outcomes in Australian maternity services, including their relationship to Casemix. It will also examine how these factors intersect and impact existing service models, emerging service models and, most importantly, contemporary consumer demand, community expectations of health care, and health outcomes for women and babies in the short and long term. Central to this purpose, the paper offers a dual critique: a) that the principles, foundation and model for funding maternity service provision in Australia within acute hospital services is seriously flawed and a significant driver for increased expenditure as well as unnecessary clinical interventions in healthy women and babies, and short term adverse health outcomes for mothers, babies and families; it also results in a larger, hitherto unacknowledged systems legacy with significant implications for long term health and economic outcomes of the population, including future health system management of the burden of chronic disease; b) that there is a current mismatch between policy and funding structure whereby biomedical/acute care models of service delivery for healthy pregnant women and babies are broadly privileged as the dominant paradigm for maternity services. This constitutes incoherent health policy and is inconsistent with both medical research and evidence- based ‘best practice,’ including a population health approach to delivery of maternity services and the view that good maternity service provision can act as a population level preventative health strategy. The paper uses Ulrich’s Systematic Boundary Critique (1) as a framework to make transparent the limitations and dysfunction of the current system and to propose an alternative design which has the capacity to improve equity, access, clinical outcomes, and reconfiguration and utilization of the skilled midwifery workforce. The new design can contribute reduced health care costs, labour force efficiency, staff retention, and economically sustainable services. The paper concludes that a national approach to policy and structural funding reform that relocates mainstream maternity services for healthy women and babies within a primary health care paradigm is urgently required in Australia, and is aligned with widespread consumer lobbying for such reform

Managing professionals : the emerging leadership role of Victorian Maternal and Child Health coordinators

Drawing on research into cultural and organizational change in the Victorian Maternal and Child Health Service during the 1990s, this paper examines implications for the nursing leadership provided by service coordinators. The project included a quantitative survey of nurses and semistructured interviews with managers and coordinators. Under a strongly neoliberal state government in Victoria, Australia, services were fundamentally restructured through tendering processes. A competitive, productivist culture was introduced that challenged the professional ethos of nurses and a primary health orientation to the care of mothers and infants. This paper focuses on the pressures that the entrepreneurial environment presented to maternal and child health nurses\u27 identity and collegial relations and to the coordination role. It argues that coordinators emerged as a Significant nursing management group at the interface of administrative change and the management of professional practice. Although many nurses skilfully negotiated tensions with peers and management, their leadership role needs further clarification and support.<br /

\u27How can we go on caring when nobody here cares about us?\u27 Australian public maternity units as contested care sites

BACKGROUND: Provision of personalised, continuous care focused on \u27well women\u27 is now central to midwifery identity and work ideals, but it remains difficult in hospital contexts shaped by increased demand and by neoliberal policies. Previous accounts of occupational and work-family conflicts in midwifery and nursing have pointed to the \u27moral distress\u27 associated with managing conflicting expectations in health workplaces. QUESTION: This paper examines these issues in the Australian context and considers further the ethical implications of midwives not feeling \u27cared for\u27 themselves in health care organisations. METHODS: Qualitative research in several Victorian maternity units included use of interviews and observational methods to explore staff experiences of organisational and professional change. Data were coded and analysed using NVivo. FINDINGS: Midwives reported frequent contestation as they sought to practice their ideal of themselves as caregivers in what they reported as often \u27uncaring\u27 workplaces. To interpret this data, we argue for seeing midwifery caring as embodied social practice taking place within \u27organisation carescapes\u27. CONCLUSION: Theoretical analysis of the moral and ethical dimensions of the contemporary organisational structure of maternity care suggests that a practice-based and dialogical ethic should form the core principle of care both for women in childbirth and for their carers