Obstetrician warns over hospital cuts

ONE of only three doctor-obstetricians delivering babies at the Murwillumbah District Hospital said he will quit helping mums assisting women to give birth there if a rumoured downgrade to maternity services goes ahead.

Dr Ian Kettle has been assisting Tweed mums to have their babies at Murwillumbah for close to 21 years, and says lives will be placed at risk if the emergency obstetrics facilities are removed from the hospital and the maternity ward is downgraded to only deal with low-risk births and elective caesareans. "If the North Coast Area Health Service cannot provide the specialist obstetrics back-up that I need to be confident in assisting mothers deliver their babies, then I would no longer offer my services to local mums," Dr Kettle told The Tweed Daily News yesterday.

"Without the support of specialist obstetric services, with the number of mums that go through there between 350 to 400 births per year -- it will be unsafe for mother and baby.

"If a member of my family was pregnant and I knew that where they were having their baby there would not be a timely response from appropriate medical services, then I would not recommend that she delivers there.

"I could not, in good conscience, continue to assist with births if I could not give my patient a guarantee that they will have help readily available to them if they need it."

More than 6000 people marched through the Murwillumbah CBD on Saturday to protest the rumoured downgrade of maternity services at the hospital, with local doctors and nurse representatives speaking out for the first time about the threat facing the ward that has been operating with only one obstetrician instead of two for the past 18 months.

Area health service boss Chris Crawford said while it would be inappropriate to pre-empt the outcome of the ongoing external review of clinical services at the hospital, the report was still a draft and consultative meetings are still being held, with this input being considered by the review team before they produce their final report.

"However, it should be noted that bringing more services to Murwillumbah hospital is a matter under consideration," Mr Crawford said in a statement yesterday.

"Notably in regard to the performing of more elective caesarean sections and the management of more low-risk birthing.

"In this scenario, the more acute maternity work would be conducted at The Tweed Hospital, which has a large range of specialised services and a well-staffed after-hours operating theatre."

The model described by Mr Crawford is already in place in small hospitals like Mullumbimby and Casino, Dr Kettle said, but it is questionable whether the facilities provide any cost savings, or improved efficiencies, for the health service.

"Only the lowest-risk patients can give birth at Mullumbimby, but about 20 per cent of them had to have an emergency caesarean and so had to be transported to Tweed Heads," Dr Kettle explained.

"They have about 140 natural births there every year, and about 40 patients are transported during labour due to some problem.

"So from those figures you can extrapolate that if the model is brought in at Murwillumbah that will result in about 80 or more patients being transferred during labour, putting extra strain on the already over-stretched obstetric services at Tweed Heads," he said.

With only another two doctors assisting with births at the Murwillumbah hospital, Dr Doug Warne and Dr Joe Biles, Dr Kettle said this model would rely heavily on the support of these doctors, who are already overstretched coping with increased workloads.

"I would normally deliver about 50 babies per year, but since the hospital has only one obstetrician my workload has more than trebled. Just last month I delivered 16 babies," Dr Kettle said.

"Ideally I would like to assist with one birth a week, but at the moment I am doing about four to five births a week, and that is on top of my regular work as a general practitioner."



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