There was no room in the labour ward of a Perth hospital when San-Mari Andrea Krugel turned up after feeling contractions.
- Hundreds of expectant mothers have been bypassed over the past year
- Advocates are pushing for more midwife-led maternity care
- The state government says workforce shortages are a huge hurdle
She had received all her previous maternity care at this hospital, but on the day her baby Mias was supposed to arrive, she was turned away.
“I was under the impression that [if] I booked in at Osborne Park, I will have my baby at Osborne Park no matter what,” she said.
“Am I just going to have my baby on the floor? What’s going on?”
For more than 12 hours, Ms Krugel and her husband were stuck in limbo with no idea where they would end up.
Eventually, a space opened up at the Armadale Health Service, about a 45-minute drive away.
“We are extremely grateful to all the staff for how they handled the entire ordeal,” Ms Krugel said.
“Even though it was really tough, it could have been a lot worse.”
Hundreds of pregnant mothers turned away
Hospitals in the Perth metropolitan area have been forced to turn away expectant mothers during times of high demand.
Figures from WA’s Department of Health show pregnant women were bypassed or diverted from Perth hospitals 311 times between June 2021 and May 2022.
In some cases, they had to travel for up to an hour from St John of God Midland Public Hospital to Northam Hospital, about 80 kilometres away.
Maternity bypass has also occurred at Fiona Stanley Hospital, Osborne Park Hospital and Rockingham General Hospital.
Ms Krugel said the ordeal had eroded her trust in the public health system.
“Just for my peace of mind, next time I’ll go private,” she said.
Ms Krugel was hoping for a natural birth, but needed to undergo an emergency caesarean section, which she partially blames on anxiety resulting from the situation.
“[The baby’s] heart rate was all over the place because of all the stress,” she said.
“Part of me thinks that if we hadn’t had to move hospitals, I might have been … more likely to give birth the way I wanted to.”
C-sections on the rise
The World Health Organization states the ideal rate for births through C-section should be between 10 and 15 per cent.
The proportion of births by C-section in Australia has been sitting above 30 per cent and rising for more than a decade.
In WA, it’s risen from 33 per cent in 2008 to more than 40 per cent in 2022, according to figures from the WA Department of Health.
Having an emergency C-section significantly contributes to the risk of postnatal anxiety, depression and PTSD following childbirth.
Advocates push for midwife-led births
Consumer advocacy group Maternity Choices Australia says stressful childbirths, including from being bypassed, can also contribute to an increased risk of postnatal mental health conditions.
The advocacy group is penning a brief to WA’s health minister about the state’s maternity services.
“Emotional trauma is going through the roof,” vice president Azure Rigney said.
Ms Rigney said allowing midwife-led units to handle low-risk pregnancies would reduce the need for diverting mothers to other hospitals.
“It’s like a birth centre, a midwife-led unit where they’ve got all the life saving equipment … it just means you don’t have caesarean section facilities and doctor input,” she said.
“If there was anything very rare and complicated for a low-risk woman in that setting, what we’ve learned through COVID is that the midwife can Facetime the obstetrician and have that specialist input if required.”
‘Something’s got to change’: midwife
But it may be difficult to implement Ms Rigney’s recommendations amid a country-wide workforce shortage.
The North Metropolitan Health Service described maternity bypass as “standard operating practice” to deal with high demand.
“WA hospitals work together to ensure all birthing mothers are able to access midwifery care at all times,” a spokesperson said.
“This may mean that some women are transferred to less busy maternity units.”
But a midwife who works at a Perth metropolitan hospital told the ABC it placed undue stress on hospitals that receive the diverted patients.
“Other hospitals that go on bypass … cause us to take their women,” they said.
“It leaves the women who are from our facility, sometimes they are the ones that have to wait.”
The midwife told the ABC some hospitals are put on maternity bypass almost daily.
“It just boils down to funding all the time.”
“We can’t hire midwives because we need funding. We can’t get better equipment because we need funding.”
Plea for retired midwives to return
The state government has recently written to retired midwives to try and encourage them to return to work.
“It’s no secret that we are facing workforce pressures,” health minister Amber-Jade Sanderson said.
Ms Sanderson described maternity bypasses as “unfortunate” but “necessary to ensure women can birth safely” when certain hospitals are unable to meet demand.
“I understand that being told to attend another hospital has the potential to be very stressful for expectant mothers,” she said.
“But I am confident that no matter where a Western Australian woman gives birth, she will be receiving the highest quality of care.
“The decision to divert or transfer birthing mothers is always made in the interests of patient safety.”