Proserpine Hospital - Queensland Centre for Mothers & Babies
Proserpine Hospital - Queensland Centre for Mothers & Babies
Proserpine Hospital - Queensland Centre for Mothers & Babies
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Consumer Evaluation of Maternity Care Per<strong>for</strong>mance in 2010<br />
<strong>Proserpine</strong> <strong>Hospital</strong>
This report was prepared by the <strong>Queensland</strong> <strong>Centre</strong> <strong>for</strong> <strong>Mothers</strong> & <strong>Babies</strong>, an independent research centre based at The<br />
University of <strong>Queensland</strong> and funded by the <strong>Queensland</strong> Government. The following people contributed to the preparation of this<br />
report: Yvette D. Miller, Samantha J. Prosser, Rachel Thompson, Aleena M. Wojcieszek, Julie Porter, Ashleigh Armanasco, Peter<br />
Coxeter and Sue Kruske.<br />
Suggested Citation<br />
<strong>Queensland</strong> <strong>Centre</strong> <strong>for</strong> <strong>Mothers</strong> & <strong>Babies</strong>. (2012). Consumer Evaluation Report of Maternity Care Per<strong>for</strong>mance in 2010:<br />
<strong>Proserpine</strong> <strong>Hospital</strong>. Brisbane, Australia: The University of <strong>Queensland</strong>.<br />
© Copyright The University of <strong>Queensland</strong> 2012<br />
Items may be reproduced free of charge in any <strong>for</strong>mat or medium provided that they are not <strong>for</strong> commercial resale. This consent<br />
is subject to the material being reproduced accurately and not used in a derogatory manner or misleading context. The material<br />
should be acknowledged as © Copyright The University of <strong>Queensland</strong> 2012 with the title of the document specified.<br />
2
Contents<br />
Acknowledgements .................................................................................................................................................................... 5<br />
Introduction ................................................................................................................................................................................ 6<br />
Background ............................................................................................................................................................................ 6<br />
The 2010 Having a Baby in <strong>Queensland</strong> Survey ...................................................................................................................... 6<br />
About This Report ................................................................................................................................................................... 6<br />
Using this Report <strong>for</strong> Quality Improvement ............................................................................................................................... 7<br />
Finding Out More .................................................................................................................................................................... 7<br />
Statewide Snapshot ................................................................................................................................................................... 8<br />
Response Rate ....................................................................................................................................................................... 8<br />
Representativeness of Respondents ....................................................................................................................................... 9<br />
Per<strong>for</strong>mance Summary: <strong>Proserpine</strong> <strong>Hospital</strong> ............................................................................................................................. 10<br />
Part A: Quality of Interpersonal Care ......................................................................................................................................... 10<br />
Indicator 1: How well are women looked after at this facility ................................................................................................. 12<br />
Indicator 2: Would women recommend this facility to a friend .............................................................................................. 13<br />
Part B: Access to Care ............................................................................................................................................................. 14<br />
Indicator 3: Do women have a booking appointment by 18 weeks’ gestation ...................................................................... 15<br />
Indicator 4: Do women receive a home visit or telephone call within 10 days of discharge ................................................... 16<br />
Part C: Attention from Care Providers ....................................................................................................................................... 17<br />
Indicator 5: Do women have continuity of carer during labour and birth ............................................................................... 18<br />
Indicator 6: Are women satisfied with the amount of care during their postnatal stay ........................................................... 19<br />
Part D: Respectful Care ............................................................................................................................................................ 20<br />
Indicator 7: Do care providers treat women with respect ..................................................................................................... 21<br />
Indicator 8: Do care providers treat women with kindness and understanding ..................................................................... 22<br />
Indicator 9: Do care providers genuinely care about women’s wellbeing .............................................................................. 23<br />
Indicator 10: Do care providers respect women’s decisions ................................................................................................ 24<br />
Part E: Support <strong>for</strong> Consumer Preferences ............................................................................................................................... 25<br />
Indicator 11: Are women’s support people made to feel welcome during labour and birth ................................................... 26<br />
Indicator 12: Are women’s support people made to feel welcome after birth ....................................................................... 27<br />
Indicator 13: Can women choose the gender of their care provider(s) <strong>for</strong> labour and birth .................................................... 28<br />
Indicator 14: Do care providers allow women to take their time during labour ...................................................................... 29<br />
Indicator 15: Do women feel that their medical procedures were necessary ......................................................................... 30<br />
Part F: In<strong>for</strong>med Decision-Making by Consumers ...................................................................................................................... 31<br />
Indicator 16: Do women make in<strong>for</strong>med decisions about caesarean section ........................................................................ 32<br />
Indicator 16.1: Caesarean section scheduled in advance ................................................................................................... 32<br />
Indicator 16.2: Caesarean section not scheduled in advance ............................................................................................. 33<br />
Indicator 17: Do women make in<strong>for</strong>med decisions about induction of labour ....................................................................... 34<br />
Indicator 18: Do women make in<strong>for</strong>med decisions about vaginal examinations .................................................................... 35<br />
Indicator 19: Do women make in<strong>for</strong>med decisions about fetal monitoring ............................................................................ 36<br />
Indicator 20: Do women make in<strong>for</strong>med decisions about epidural during labour .................................................................. 37<br />
3
Part G: Quality of Labour and Birth Rooms ............................................................................................................................... 38<br />
Indicator 21: Was the cleanliness of the labour and birth rooms adequate ........................................................................... 39<br />
Indicator 22: Was the privacy of the labour and birth rooms adequate ................................................................................. 40<br />
References ............................................................................................................................................................................... 41<br />
4
Acknowledgements<br />
Women who participated in the Having a Baby in <strong>Queensland</strong> 2010 Survey generously offered to share their experiences of<br />
maternity care in <strong>Queensland</strong>. Without their valuable perspectives, evaluation of services from a consumer perspective to in<strong>for</strong>m<br />
quality improvement ef<strong>for</strong>ts would not be possible.<br />
The <strong>Queensland</strong> Registry of Births, Deaths and Marriages contacted women to invite them to participate and were committed to<br />
ensuring women’s privacy was protected throughout the process.<br />
The Having a Baby in <strong>Queensland</strong> Survey Program was established by Yvette Miller, Rachel Thompson and Christina Lee. Yvette<br />
Miller, Samantha Prosser, Rachel Thompson, Aleena Wojcieszek, Julie Porter and Ashleigh Armanasco developed the 2010<br />
survey instrument, data collection methods and development of per<strong>for</strong>mance indicators on which this report is based. Samantha<br />
Prosser conducted the data analysis <strong>for</strong> this report. The design of this report was developed by Yvette Miller and Hazel Brittain in<br />
consultation with Kirstine Sketcher-Baker, David Park and Kew Walker from the <strong>Centre</strong> <strong>for</strong> Healthcare Improvement (<strong>for</strong>merly<br />
Clinical Practice Improvement <strong>Centre</strong>) and Kerry Ann Ungerer from the Primary, Community and Extended Care Branch,<br />
<strong>Queensland</strong> Health.<br />
<strong>Queensland</strong> Health provides ongoing support to the <strong>Queensland</strong> <strong>Centre</strong> <strong>for</strong> <strong>Mothers</strong> & <strong>Babies</strong> in their work towards maternity<br />
care re<strong>for</strong>m in <strong>Queensland</strong>. The Having a Baby in <strong>Queensland</strong> Survey Program is funded by the <strong>Queensland</strong> Government.<br />
5
Introduction<br />
Background<br />
The <strong>Queensland</strong> <strong>Centre</strong> <strong>for</strong> <strong>Mothers</strong> & <strong>Babies</strong> (QCMB) is an independent research centre based at The University of <strong>Queensland</strong>.<br />
The <strong>Centre</strong> was funded by the <strong>Queensland</strong> Government in 2009, in response to the findings of the Review of Maternity Services<br />
in <strong>Queensland</strong> (Hirst, 2005). A key strategic direction of the <strong>Centre</strong> is to generate and disseminate evidence that enhances the<br />
capacity of care providers and policy-makers to understand, and respond to, the requirements of women accessing maternity<br />
care.<br />
To meet this goal, the QCMB conducts population surveys to understand the maternity care experiences of women in<br />
<strong>Queensland</strong>. The surveys ask women about the care and support they received be<strong>for</strong>e, during and after the birth of their most<br />
recent baby. The surveys are an important way of collecting women’s perspectives on the quality of maternity services provided<br />
in <strong>Queensland</strong>.<br />
The 2010 Having a Baby in <strong>Queensland</strong> Survey<br />
In 2010, all women who had a live birth in <strong>Queensland</strong> between February 1 and May 30, received a Having a Baby in <strong>Queensland</strong><br />
Survey package in the mail when their baby was 4 to 5 months old. Three modes of survey completion were available to women:<br />
paper, online or telephone. Women were also given the option to complete the survey in a language other than English over the<br />
telephone, with a translator and a female interviewer (see Miller et al., 2011 <strong>for</strong> more in<strong>for</strong>mation).<br />
Data collected in the Having a Baby in <strong>Queensland</strong> Survey Program are used in several ways. Data are provided directly to<br />
<strong>Queensland</strong> Health in a comprehensive report outlining key survey findings. This report highlights differences in consumer<br />
experiences based on health sector, parity, and rurality of residence, in addition to providing recommendations <strong>for</strong> improved<br />
service delivery. An electronic copy of the report is available at www.qcmb.org.au/reports. Data are also presented in Birthplace,<br />
an online consumer guide to all birthing facilities in <strong>Queensland</strong> (www.havingababy.org.au/birthplace) 1 . Birthplace was developed<br />
to support women and their families to choose a facility <strong>for</strong> birth and/or to know what to expect from their chosen birthing facility.<br />
Birthplace can also be used by care providers and others <strong>for</strong> quality improvement purposes, and some facility-level data not<br />
included in this report can be viewed in Birthplace.<br />
About This Report<br />
This report presents the findings of the 2010 Having a Baby in <strong>Queensland</strong> Survey at an individual facility level. The report was<br />
developed as a means of providing feedback on the experiences of consumers to facilities, particularly by identifying areas of<br />
strength and opportunities <strong>for</strong> improvement in service delivery. We have selected 22 key per<strong>for</strong>mance indicators to highlight the<br />
care provided to women in each geographic region in <strong>Queensland</strong>. Rather than reporting on clinical indicators that may differ<br />
according to the case mix in a particular facility, indicators were selected based on their applicability to all women.<br />
On each per<strong>for</strong>mance indicator we provide the proportion of respondents from each birth facility within that region who reported<br />
receiving ‘gold standard care’. Gold standard care is always represented by the red bars in the graph. For some indicators (e.g.<br />
being well cared <strong>for</strong>, being treated with respect), gold standard care is achieved where women give their care the highest<br />
evaluation possible. Where data are measured on a continuous scale of 1 (lowest) to 5 (highest), gold standard care is achieved<br />
<strong>for</strong> all women who report ‘5’. Where data are measured as a proportion of time (e.g. ‘none of the time’, ‘some of the time’, ‘all of<br />
the time’), gold standard care is achieved <strong>for</strong> all women who report ‘all of the time’. We report on gold standard care as it is<br />
expected that care providers would strive <strong>for</strong> all women in the birth facility to receive the highest level of care possible <strong>for</strong> such<br />
indicators.<br />
For other indicators (e.g. timing of booking visit, postnatal contact), gold standard care is achieved where women report an<br />
experience that is consistent with current <strong>Queensland</strong> Health policies and guidelines and/or research evidence on best care<br />
practices. Again, we report on gold standard care as it is expected that care providers would strive <strong>for</strong> all women in the birth<br />
facility to report care consistent with current policies, guidelines and research evidence.<br />
1<br />
In some instances, the figures presented in this report may differ by 1% from those reported in Birthplace due to differential approaches <strong>for</strong><br />
rounding decimal places between the two systems.<br />
6
Where the total number of respondents from any facility is less than 10 on a given per<strong>for</strong>mance indicator, data are not reported<br />
at a facility level to protect respondents’ anonymity. For this reason, it was not possible to report on any indicators <strong>for</strong> the<br />
following facilities: Ayr <strong>Hospital</strong>, Charleville <strong>Hospital</strong>, Charters Towers Health <strong>Centre</strong>, Chinchilla Health Service, Cunnamulla<br />
<strong>Hospital</strong>, Roma <strong>Hospital</strong>, St George <strong>Hospital</strong>, Theodore <strong>Hospital</strong>, Thursday Island <strong>Hospital</strong>, Toowoomba Birth <strong>Centre</strong>, and Tully<br />
<strong>Hospital</strong>. Responses from women who gave birth in these facilities are included in the statewide public statistics presented in this<br />
report as this was not seen to compromise their anonymity.<br />
When reporting 2010 survey data <strong>for</strong> a consumer audience through the facility level tool, ‘Birthplace’<br />
(www.havingababy.org.au/birthplace), an additional quality assurance measure is used in that we do not report data on facilities<br />
where fewer than 25% of women who birthed in that facility in the survey period responded. This measure was adopted to<br />
provide greater confidence in the representativeness of facility-specific data. However, given that the purpose of this report is to<br />
provide feedback to facilities <strong>for</strong> quality improvement purposes, data from facilities where fewer than 25% of women who birthed<br />
in the survey period responded to the survey have been retained. Where such data are reported, an asterisk (*) is provided at the<br />
end of the facility name. Where a category on any given indicator was less than 1%, this has not been reported in the graphs.<br />
Using this Report <strong>for</strong> Quality Improvement<br />
‘Areas of highest per<strong>for</strong>mance’ are those indicators <strong>for</strong> which the largest proportion of respondents reported receiving gold<br />
standard care in this facility. ‘Areas of lowest per<strong>for</strong>mance’ are those indicators <strong>for</strong> which the smallest proportion of<br />
respondents reported receiving gold standard care in this facility. Together, these indicators highlight areas of strength in care<br />
provision (optimal per<strong>for</strong>mance) and areas needing improvement (weakest per<strong>for</strong>mance) to in<strong>for</strong>m priorities <strong>for</strong> quality<br />
improvement.<br />
The ‘best facility’ attributions <strong>for</strong> each per<strong>for</strong>mance indicator are provided <strong>for</strong> facilities in each category (public hospitals, public<br />
birth centres and private hospitals) across <strong>Queensland</strong> <strong>for</strong> whom the largest proportion of respondents reported receiving gold<br />
standard care. These facilities provide some indication of readily achievable levels of per<strong>for</strong>mance on each indicator and may<br />
provide opportunities <strong>for</strong> learning from identified models of best practice <strong>for</strong> quality improvement ef<strong>for</strong>ts.<br />
The ‘What do women say about their care’ sections provide illustrative examples of women’s reports of positive and<br />
negative experiences of care and can be used to guide quality improvement. To ensure women’s privacy, these quotes are<br />
provided from women across <strong>Queensland</strong> and are not specific to the individual facility named in the report or to those facilities<br />
identified as demonstrating best per<strong>for</strong>mance.<br />
It may also be helpful to review a facility’s per<strong>for</strong>mance against similar facilities in <strong>Queensland</strong> that are outside of this geographic<br />
region. Copies of the Consumer Evaluations of Maternity Care Per<strong>for</strong>mance reports are available <strong>for</strong> all reportable birth facilities in<br />
<strong>Queensland</strong> (i.e. where the number of survey respondents <strong>for</strong> a given facility is greater than or equal to 10 women) online at<br />
www.qcmb.org.au/facilityreports.<br />
Finding Out More<br />
In addition to the Consumer Evaluations of Maternity Care Per<strong>for</strong>mance reports <strong>for</strong> other birth facilities, some of the data included<br />
in this report, and additional facility-level data not included in this report, can be viewed in Birthplace<br />
(www.havingabay.org.au/birthplace).<br />
To contact the <strong>Queensland</strong> <strong>Centre</strong> <strong>for</strong> <strong>Mothers</strong> & <strong>Babies</strong>, please call (07) 3346 8797 or email info@qcmb.org.au. Further details<br />
about the work of the centre are also provided online at www.qcmb.org.au<br />
7
Statewide Snapshot<br />
Response Rate<br />
Public <strong>Hospital</strong>s and Birth <strong>Centre</strong>s<br />
The number and percentage of women who provided responses to the 2010 Having a Baby in <strong>Queensland</strong> Survey <strong>for</strong> each<br />
public hospital and birth centre are provided below.<br />
Number of respondents Response rate<br />
Atherton <strong>Hospital</strong> 25 35%<br />
Ayr <strong>Hospital</strong> 9 18%<br />
Biloela <strong>Hospital</strong> 12 39%<br />
Bundaberg <strong>Hospital</strong> 126 30%<br />
Caboolture <strong>Hospital</strong> 213 30%<br />
Cairns Base <strong>Hospital</strong> 212 24%<br />
Charleville <strong>Hospital</strong> 7 44%<br />
Charters Towers Health <strong>Centre</strong> 2 29%<br />
Chinchilla Health Service 8 47%<br />
Cunnamulla <strong>Hospital</strong> 1 25%<br />
Dalby <strong>Hospital</strong> 28 31%<br />
Emerald <strong>Hospital</strong> 29 33%<br />
Gladstone <strong>Hospital</strong> 41 24%<br />
Gold Coast <strong>Hospital</strong> 343 31%<br />
Gold Coast Birth <strong>Centre</strong> 28 56%<br />
Goondiwindi <strong>Hospital</strong> 12 27%<br />
Gympie <strong>Hospital</strong> 33 30%<br />
Hervey Bay <strong>Hospital</strong> 90 25%<br />
Innisfail <strong>Hospital</strong> 18 16%<br />
Ipswich <strong>Hospital</strong> 206 24%<br />
Kingaroy Health Service 40 28%<br />
Logan <strong>Hospital</strong> 266 23%<br />
Longreach <strong>Hospital</strong> 18 38%<br />
Mackay Base <strong>Hospital</strong> 96 25%<br />
Mackay Birth <strong>Centre</strong> 14 78%<br />
Mareeba <strong>Hospital</strong> 14 30%<br />
Mater <strong>Mothers</strong>’ Public <strong>Hospital</strong> 488 30%<br />
Mt Isa <strong>Hospital</strong> 36 19%<br />
Nambour <strong>Hospital</strong> 231 32%<br />
<strong>Proserpine</strong> <strong>Hospital</strong> 36 42%<br />
Redcliffe <strong>Hospital</strong> 136 28%<br />
Redland <strong>Hospital</strong> 222 33%<br />
Rockhampton <strong>Hospital</strong> 114 25%<br />
Roma <strong>Hospital</strong> 5 16%<br />
Royal Brisbane and Women’s <strong>Hospital</strong> 451 33%<br />
Royal Brisbane and Women’s Birth <strong>Centre</strong> 78 70%<br />
St George <strong>Hospital</strong> 5 23%<br />
Stanthorpe <strong>Hospital</strong> 16 29%<br />
Theodore <strong>Hospital</strong> 4 33%<br />
Thursday Island <strong>Hospital</strong> 3 5%<br />
Toowoomba <strong>Hospital</strong> 200 30%<br />
Townsville <strong>Hospital</strong> 148 21%<br />
Townsville Birth <strong>Centre</strong> 21 75%<br />
Tully <strong>Hospital</strong> 0 0%<br />
Warwick <strong>Hospital</strong> 18 30%<br />
STATEWIDE PUBLIC HOSPITALS AND BIRTH CENTRES 4,124 29%<br />
8
Private <strong>Hospital</strong>s<br />
The number and percentage of women who provided responses to the 2010 Having a Baby in <strong>Queensland</strong> Survey <strong>for</strong> each<br />
private hospital are provided below.<br />
Number of respondents Response rate<br />
Cairns Private <strong>Hospital</strong> 93 41%<br />
John Flynn Private <strong>Hospital</strong> 108 42%<br />
Mater Misericordiae <strong>Hospital</strong> Gladstone 34 46%<br />
Mater Misericordiae <strong>Hospital</strong> Mackay 122 45%<br />
Mater Misericordiae <strong>Hospital</strong> Rockhampton 110 47%<br />
Mater Women’s and Children’s <strong>Hospital</strong> Townsville 146 41%<br />
Mater <strong>Mothers</strong>’ Private <strong>Hospital</strong> (South Brisbane) 761 49%<br />
Mater <strong>Mothers</strong>’ Private Redland 68 46%<br />
Nambour Selangor Private <strong>Hospital</strong> 148 48%<br />
North West Private <strong>Hospital</strong> 297 48%<br />
Pindara Private <strong>Hospital</strong> 242 43%<br />
St Andrew’s Ipswich Private <strong>Hospital</strong> 68 50%<br />
St Vincent’s <strong>Hospital</strong> Toowoomba 175 44%<br />
Sunnybank Private <strong>Hospital</strong> 190 41%<br />
Sunshine Coast Private <strong>Hospital</strong> 83 51%<br />
Wesley Private <strong>Hospital</strong> 283 48%<br />
STATEWIDE PRIVATE HOSPITALS 2,935 46%<br />
Representativeness of Respondents<br />
The survey respondents include women who had live births (single and multiple births) in <strong>Queensland</strong> between February 1 and<br />
May 30, 2010. The representativeness of survey respondents was compared with population statistics reported <strong>for</strong> women who<br />
gave birth in <strong>Queensland</strong> in 2008 (based on Australia’s <strong>Mothers</strong> and <strong>Babies</strong>, and Perinatal Statistics <strong>Queensland</strong>) on several key<br />
indices 2 . It is important to note that these comparisons provide an estimate only of sample representativeness given that<br />
population statistics are not yet publically available <strong>for</strong> women who gave birth in 2010. Additionally, the 2008 population<br />
statistics include women who experienced a stillbirth or a neonatal death, however these women are not included in the Having a<br />
Baby in <strong>Queensland</strong> data presented in this report.<br />
Relative to the women who gave birth in <strong>Queensland</strong> in 2008 (Laws et al., 2010; <strong>Queensland</strong> Health, 2010), the respondent<br />
sample under-represented the following groups:<br />
− Multiparous women (54.6% in the respondent sample vs. 60.0% of all birthing women in <strong>Queensland</strong>)<br />
− Aboriginal and/or Torres Strait Islander women (1.7% in the respondent sample vs. 5.6% of all <strong>Queensland</strong> birthing<br />
women)<br />
− Younger women (aged
Per<strong>for</strong>mance Summary: <strong>Proserpine</strong> <strong>Hospital</strong><br />
The list below provides a summary of per<strong>for</strong>mance <strong>for</strong> <strong>Proserpine</strong> <strong>Hospital</strong> based on the 22 indicators selected <strong>for</strong> this report.<br />
Indicators are ordered from highest to lowest in terms of the proportion of women who received gold standard care at<br />
<strong>Proserpine</strong> <strong>Hospital</strong>.<br />
Indicator 11: Are women’s support people made to feel welcome during labour and birth 100%<br />
Areas of<br />
highest<br />
per<strong>for</strong>mance:<br />
Indicator 12: Are women’s support people made to feel welcome after birth 100%<br />
Indicator 21: Was the cleanliness of the labour and birth rooms adequate 100%<br />
Indicator 2: Would women recommend this facility to a friend 97%<br />
Indicator 7: Do care providers treat women with respect 97%<br />
Indicator 9: Do care providers genuinely care about women’s wellbeing 94%<br />
Indicator 22: Was the privacy of the labour and birth rooms adequate 94%<br />
Indicator 8: Do care providers treat women with kindness and understanding 92%<br />
Indicator 4: Do women receive a home visit or telephone call within 10 days of discharge 86%<br />
Indicator 10: Do care providers respect women’s decisions 86%<br />
Indicator 14: Do care providers allow women to take their time during labour 78%<br />
Indicator 15: Do women feel that their medical procedures were necessary 77%<br />
Indicator 6: Are women satisfied with the amount of care during their postnatal stay 75%<br />
Indicator 1: How well are women looked after at this facility 73%<br />
Indicator 5: Do women have continuity of carer during labour and birth 71%<br />
Indicator 3: Do women have a booking appointment by 18 weeks’ gestation 23%<br />
Indicator 19: Do women make in<strong>for</strong>med decisions about fetal monitoring 5%<br />
Areas of lowest<br />
per<strong>for</strong>mance:<br />
Indicator 13: Can women choose the gender of their care provider(s) <strong>for</strong> labour and birth 3%<br />
Indicator 18: Do women make in<strong>for</strong>med decisions about vaginal examinations 0%<br />
Indicators with insufficient data<br />
Indicator 16.1:<br />
Indicator 16.2:<br />
Indicator 17:<br />
Indicator 20:<br />
Do women make in<strong>for</strong>med decisions about caesarean sections scheduled in advance<br />
Do women make in<strong>for</strong>med decisions about caesarean sections not scheduled in<br />
advance<br />
Do women make in<strong>for</strong>med decisions about induction of labour<br />
Do women make in<strong>for</strong>med decisions about epidural during labour<br />
10
Part A: Quality of Interpersonal Care<br />
Quality of interpersonal care reflects an overall assessment of the standard of non-clinical care received from the perspective of<br />
the consumer. While the quality of clinical care is regularly recorded and reported on, the quality of interpersonal care and patient<br />
experience is assessed far less frequently. It is important that aspects of interpersonal care are assessed as these factors are<br />
associated with patient satisfaction and overall engagement with health services (Watson & Gallois, 2007).<br />
We have reported on two indicators of the quality of interpersonal care.<br />
Indicator 1: How well are women looked after at this facility<br />
The safety and quality of maternity care in <strong>Queensland</strong> are currently monitored via a number of different mechanisms at<br />
organisational, district, and state-wide levels. Maternity care consumer assessments of the overall standard of interpersonal care<br />
are critical to complement existing measures of the safety and quality of maternity care in <strong>Queensland</strong>.<br />
Indicator 2: Would women recommend this facility to a friend<br />
Whether a patient would recommend their care provider, health facility, or treatment, is a reliable and widely used indicator of a<br />
positive experience of care (Dodd et al., 2004; Halfon et al., 2004; Murray-Davis et al., 2012). As such, recommending their birth<br />
facility to a friend is a good reflection of how favourably women view their chosen birth facility.<br />
11
Indicator 1: How well are women looked after at this facility<br />
Gold standard care is defined as women feeling that they were looked after ‘very well’ during labour and birth. As such, best<br />
facilities are those where the highest percentage of women said that they were looked after ‘very well’ during labour and birth.<br />
We asked: “Overall, how well were you looked after by your care provider(s) during labour and birth”<br />
The graph displays the percentage of women who said that they were looked after ‘very well’ (‘5’), as well as the percentages of<br />
women who gave a rating of ‘4’, ‘3’, ‘2’ and ‘1’ (‘very badly’) on the same scale.<br />
5 = Very well 4 3 2 1 = Very badly<br />
STATEWIDE PUBLIC<br />
63<br />
24<br />
9<br />
3 1<br />
Mackay Base <strong>Hospital</strong> (n=96)<br />
56<br />
28<br />
11<br />
3 2<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=36)<br />
73<br />
19<br />
8<br />
STATEWIDE PRIVATE<br />
80<br />
17<br />
3<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=119)<br />
84<br />
12<br />
3 1<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Mareeba <strong>Hospital</strong> 93%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
John Flynn Private <strong>Hospital</strong> 89%<br />
What do women say about their care<br />
“The midwives and obstetricians work together to<br />
provide individual care to the parents during labour &<br />
the baby afterwards. The hospital is like a home.<br />
Lovely experience utmost respect is given to parent<br />
decisions. We felt very safe.”<br />
“My largest disappointment about having my baby,<br />
was the lack of choices and options I was given at all<br />
times during my pregnancy and labour. I was really<br />
treated as a number. It was all very impersonal. My<br />
birth plan was disregarded by all staff.”<br />
12
Indicator 2: Would women recommend this facility to a friend<br />
Gold standard care is defined as women feeling that they would recommend the hospital or birth centre to a friend.<br />
We asked: “Would you recommend this hospital or birth centre to a friend”<br />
The graph displays the percentage of women who said that they would recommend their hospital or birth centre to a friend.<br />
STATEWIDE PUBLIC<br />
91<br />
Mackay Base <strong>Hospital</strong> (n=94)<br />
90<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=36)<br />
97<br />
STATEWIDE PRIVATE<br />
96<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=122)<br />
95<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Dalby <strong>Hospital</strong> 100%<br />
Emerald <strong>Hospital</strong> 100%<br />
Goondiwindi <strong>Hospital</strong> 100%<br />
Innisfail <strong>Hospital</strong>* 100%<br />
Mareeba <strong>Hospital</strong> 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Gold Coast Birth <strong>Centre</strong> 100%<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Royal Brisbane and Women’s Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
Mater Misericordiae <strong>Hospital</strong> Gladstone 100%<br />
What do women say about their care<br />
“The staff were very helpful and caring. The help with<br />
breastfeeding was wonderful and I would recommend<br />
[facility name] to everyone.”<br />
“The labour and birth care is good; do not recommend<br />
the aftercare though”<br />
“They treated me and my husband very good and<br />
respected any decisions we made. I couldn't<br />
recommend the hospital highly enough.”<br />
“They [the midwives] are nasty and unprofessional…I<br />
felt really uncom<strong>for</strong>table…Really bad communication<br />
between doctors, midwives and other nurses…It seems<br />
chaos and confusion reigned…I would never<br />
recommend the hospital.”<br />
* Denotes a response rate of less than 25%<br />
13
Part B: Access to Care<br />
Access to care focuses specifically on the availability and provision of antenatal and postnatal care. Access to care per<strong>for</strong>mance<br />
indicators were derived from <strong>Queensland</strong> Health targets <strong>for</strong> best practice including targets <strong>for</strong> early initiation of antenatal care and<br />
establishing Universal Postnatal Contact following hospital discharge.<br />
We have reported on two indicators of access to care.<br />
Indicator 3: Do women have a booking appointment by 18 weeks’ gestation<br />
Earlier initiation of contact with health care professionals during pregnancy has been shown to affect maternal and infant<br />
postnatal outcomes (Villar et al., 2001). According to the <strong>Queensland</strong> Health Recommended Minimum Antenatal Schedule, a<br />
midwife booking-in visit should occur between 12 and 18 weeks’ gestation (<strong>Queensland</strong> Government, 2010a). The Royal<br />
Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) also advocates <strong>for</strong> early initiation of<br />
maternity care and proposes that booking appointments should ideally occur by 12 weeks gestation (RANZCOG, 2011).<br />
Indicator 4: Do women receive a home visit or telephone call within 10 days of discharge<br />
The Universal Postnatal Contact Initiative identified goals <strong>for</strong> ensuring all maternity care consumers receive follow-up contact<br />
(either by telephone or by home visit) after hospital discharge (<strong>Queensland</strong> Government, 2010b). This initiative aims to improve<br />
integration of maternity care between hospital and community health services <strong>for</strong> women and their babies.<br />
14
Indicator 3: Do women have a booking appointment by 18 weeks’ gestation<br />
Gold standard care is defined as women having a booking appointment by 18 weeks’ gestation.<br />
We asked: “How many weeks pregnant were you when you had your ‘booking’ appointment” 4<br />
The graph displays the percentage of women who said that they had a booking appointment by 18 weeks’ gestation.<br />
STATEWIDE PUBLIC<br />
69<br />
Mackay Base <strong>Hospital</strong> (n=86)<br />
70<br />
Mackay Birth <strong>Centre</strong> (n=13)<br />
77<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=35)<br />
23<br />
STATEWIDE PRIVATE<br />
57<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=111)<br />
17<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Redland <strong>Hospital</strong> 88%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Gold Coast Birth <strong>Centre</strong> 85%<br />
What do women say about their care<br />
“Found [facility name] staff very welcoming and supportive<br />
of all decisions. I was really impressed with the attention to<br />
detail they went through on the first appointment, the<br />
midwife went through the PHR book and asked all family<br />
history etc. questions, rather than filing it out myself as I<br />
had to do <strong>for</strong> previous pregnancy elsewhere.”<br />
“Prepare yourself <strong>for</strong> long waits <strong>for</strong> your appointment and<br />
never expect to see the same person twice”<br />
Best private hospital in <strong>Queensland</strong>:<br />
North West Private <strong>Hospital</strong> 90%<br />
“I felt a bit rushed on both appointments during my<br />
pregnancy”<br />
4<br />
This data was collected in relation to women’s planned place of birth rather than their actual place of birth. Only a small proportion of women<br />
sampled (less than 5%) indicated that their baby was not born at their planned place of birth. This proportion includes babies who were born<br />
be<strong>for</strong>e arrival.<br />
15
Indicator 4: Do women receive a home visit or telephone call within 10 days of<br />
discharge<br />
According to the <strong>Queensland</strong> Health Universal Postnatal Contact Initiative, gold standard care is defined as women being<br />
contacted by a care provider (either by telephone or by home visit) within 7-10 days of discharge from hospital.<br />
We asked: “In the first 10 days of being at home with your baby, did any of the following happen...” Women could indicate that<br />
they were telephoned by a midwife or nurse and/or received a home visit from a midwife or nurse, or that they were not<br />
contacted by a midwife or nurse.<br />
The graph displays the percentage of women who said they were telephoned by a midwife or nurse and/or received a home visit<br />
from a midwife or nurse, as well as the percentage of women who received neither a telephone call nor a home visit, in the first<br />
10 days of being at home. Three shades of red are used in the graph to represent the different types of gold standard care<br />
reported by women.<br />
Visit and call Visit only Call only Neither visit nor call<br />
STATEWIDE PUBLIC<br />
37<br />
30<br />
19<br />
14<br />
Mackay Base <strong>Hospital</strong> (n=96)<br />
48<br />
28<br />
16<br />
8<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
65<br />
14<br />
21<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=36)<br />
33<br />
6<br />
47<br />
14<br />
STATEWIDE PRIVATE<br />
2<br />
5<br />
15<br />
78<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=121)<br />
2 2<br />
31<br />
65<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Redcliffe <strong>Hospital</strong> 99%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Gold Coast Birth <strong>Centre</strong> 100%<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
North West Private <strong>Hospital</strong> 63%<br />
What do women say about their care<br />
“The pre and post birth support (midwife visits to your<br />
home <strong>for</strong> up to six weeks following bub’s arrival) meant<br />
that we have experienced a completely smooth and<br />
happy transition of our bub into our lives and home. The<br />
guidance and support provided by [model of care] during<br />
the pregnancy and post birth left us confident and able<br />
first time parents”<br />
“I wish I had more access to aftercare <strong>for</strong> my baby…A<br />
child health care nurse that you could contact, go and<br />
see or have visit me in my own home. May have helped<br />
settle my new baby quicker, in that I would have had<br />
answers sooner.”<br />
16
Part C: Attention from Care Providers<br />
Attention from care providers refers to the nature of contact with maternity care providers women have during labour, birth and<br />
the postnatal stay in hospital. Having sufficient contact between women and care providers is important <strong>for</strong> building rapport,<br />
ensuring consistent provision of care and in<strong>for</strong>mation, and aiding early detection of potential maternal or infant health needs or<br />
risks.<br />
We have reported on two indicators of attention from care providers.<br />
Indicator 5: Do women have continuity of carer during labour and birth<br />
Having continuity of carer during labour and birth (i.e. having at least one individual care provider who remains caring <strong>for</strong> a<br />
woman throughout her labour and birth) is highly valued by maternity care consumers in <strong>Queensland</strong> (Thompson & Wojcieszek,<br />
under review).<br />
Indicator 6: Are women satisfied with the amount of care during their postnatal stay<br />
Care received during the postnatal stay has been rated less favourably by women in other Australian states than the care<br />
received during pregnancy, labour and birth (Brown et al., 2005). It is important that women are adequately supported during this<br />
time, particularly given the number of transitions that may be occurring in addition to being in an unfamiliar environment. The<br />
preferred amount and frequency of support during a postnatal stay may vary across women depending on their individual<br />
circumstances, thus it is important <strong>for</strong> care providers to be attentive and communicate effectively with women to ensure they are<br />
receiving the right level of attention.<br />
17
Indicator 5: Do women have continuity of carer during labour and birth<br />
Gold standard care is defined as women having at least one maternity care provider (i.e., the same person) care <strong>for</strong> them right<br />
through labour and birth (or through birth <strong>for</strong> women who do not have labour).<br />
We asked: “Was there at least one maternity care provider who cared <strong>for</strong> you right through your labour/birth”<br />
The graph displays the percentage of women who said they had at least one care provider who cared <strong>for</strong> them right through<br />
labour and birth.<br />
STATEWIDE PUBLIC<br />
69<br />
Mackay Base <strong>Hospital</strong> (n=92)<br />
67<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
86<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=35)<br />
71<br />
STATEWIDE PRIVATE<br />
86<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=122)<br />
89<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Mareeba <strong>Hospital</strong> 100%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Gold Coast Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
Wesley Private <strong>Hospital</strong> 94%<br />
What do women say about their care<br />
“I had a single midwife who cared <strong>for</strong> me throughout my pregnancy,<br />
labour/birth and <strong>for</strong> 6 weeks after the birth. I felt com<strong>for</strong>table<br />
knowing that I could contact her at any time if I had concerns, and I<br />
knew that she would always talk with me in a genuine, honest and<br />
respectful manner…I felt com<strong>for</strong>table and safe in her care and knew<br />
that she was aware of my wishes and concerns relating to the birth<br />
and felt that I could completely trust her.”<br />
“I had a change of 4 midwives through my last stages of labour,<br />
personally speaking it was very unsettling having midwives exchange<br />
notes mid-way and having go through introductions of your new<br />
midwives whilst in pain.”<br />
“Constantly seeing 'stand in' midwives meant I did not receive<br />
consistent or adequate care and advice.”<br />
18
Indicator 6: Are women satisfied with the amount of care during their postnatal<br />
stay<br />
Gold standard care is defined as women feeling that the amount they were checked on by their care provider(s) during the<br />
postnatal stay was ‘about right’.<br />
We asked: “Thinking about how often a care provider came and ‘checked’ on you during your stay in the hospital or birth centre,<br />
was this... about right not often enough too often”<br />
The graph displays the proportion of women who said that the amount their care provider(s) checked on them was ‘about right’,<br />
‘not often enough’ and ‘too often’, during their postnatal stay.<br />
About right Not often enough Too often<br />
STATEWIDE PUBLIC<br />
74<br />
23<br />
3<br />
Mackay Base <strong>Hospital</strong> (n=95)<br />
83<br />
17<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
93<br />
7<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=36)<br />
75<br />
25<br />
STATEWIDE PRIVATE<br />
86<br />
11<br />
3<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=122)<br />
93<br />
7<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Innisfail <strong>Hospital</strong>* 94%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
Mater Misericordiae <strong>Hospital</strong> Mackay 93%<br />
Mater <strong>Mothers</strong>’ Private Redland 93%<br />
What do women say about their care<br />
“All of the staff were extremely helpful and supportive<br />
and friendly but at the same time were very<br />
respectful of your privacy and space. I always felt<br />
that they were there <strong>for</strong> myself or my baby if I<br />
needed them day or night.”<br />
“Labour and birth good. After care, not so good.<br />
Staff too busy, not enough of them.”<br />
* Denotes a response rate of less than 25%<br />
19
Part D: Respectful Care<br />
Respectful care includes treating women with dignity, courtesy, kindness and understanding. Respectful care acknowledges<br />
women’s individuality, reflects genuine care <strong>for</strong> their wellbeing, and allows them the time they need to make decisions. In an<br />
attempt to avoid typically high and less useful global ratings of health care, researchers have begun to move away from the<br />
concept of patient satisfaction and focus on more useful specific patient experiences of care (Wiegers, 2009).<br />
We have reported on four indicators of respectful care.<br />
Indicator 7: Do care providers treat women with respect<br />
The Australian Charter of Healthcare Rights highlights that “patients and consumers have a right to receive care in a manner that<br />
is respectful of their culture, beliefs, values and characteristics like age and gender” (ACSQHC, 2009). Women in receipt of<br />
maternity care services have a right to be treated with dignity and consideration by their care providers. The Code of Good<br />
Medical Practice states that “good medical practice involves treating your patients with respect at all times” (AMC, 2009), which<br />
can be used as a target <strong>for</strong> delivering gold standard care.<br />
Indicator 8: Do care providers treat women with kindness and understanding<br />
To provide holistic care during labour and birth, care providers should ensure that women’s needs are met both physically and<br />
psychologically (ANMC, 2006). Having a care provider who demonstrates support and compassion is rated very highly by<br />
women as contributing to a positive experience of labour and birth (Lavender et al., 1999).<br />
Indicator 9: Do care providers genuinely care about women’s wellbeing<br />
Woman-centred care is care that prioritises the needs and preferences of each individual woman over the needs of care<br />
providers, facilities and the maternity care system. Demonstrating genuine care <strong>for</strong> women’s wellbeing can be seen as a<br />
component of delivering care that is genuinely woman-centred.<br />
Indicator 10: Do care providers respect women’s decisions<br />
The Australian Medical Council supports the view that in order to deliver good patient care, care providers must respect and<br />
recognise that patients have a right to make their own decisions about their care (AMC, 2009). While care providers have a<br />
responsibility to provide unbiased in<strong>for</strong>mation about all available options, the final decision in any given situation ultimately<br />
remains at the discretion of the patient. Part of respecting a woman in maternity care is also respecting her ability to make<br />
decisions that are best suited to her individual needs and circumstances.<br />
20
Indicator 7: Do care providers treat women with respect<br />
Gold standard care is defined as women feeling that they were treated with respect ‘all of the time’.<br />
We asked women how frequently the following statement was reflective of their care: “When I saw care providers during my<br />
labour and birth, they treated me with respect.” Women could indicate ‘all of the time’, ‘some of the time’ or ‘not at all’.<br />
The graph displays the percentages of women who said that their care providers treated them with respect ‘all of the time’,<br />
‘some of the time’ and ‘not at all’.<br />
All of the time Some of the time Not at all<br />
STATEWIDE PUBLIC<br />
85<br />
14<br />
1<br />
Mackay Base <strong>Hospital</strong> (n=95)<br />
82<br />
17<br />
1<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=36)<br />
97<br />
3<br />
STATEWIDE PRIVATE<br />
93<br />
7<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=121)<br />
94<br />
6<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Goondiwindi <strong>Hospital</strong> 100%<br />
Longreach <strong>Hospital</strong> 100%<br />
Mareeba <strong>Hospital</strong> 100%<br />
Stanthorpe <strong>Hospital</strong> 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Gold Coast Birth <strong>Centre</strong> 100%<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
What do women say about their care<br />
“The midwife team never used fear as a motivator<br />
but operated from a positive focus to achieve the<br />
best outcome <strong>for</strong> both me and my baby. It was such<br />
a positive experience and I felt safe, respected and<br />
supported throughout the labour/birth this to me is<br />
the best way to have a baby.”<br />
“After delivery and my shower, I had to wait in the<br />
delivery room <strong>for</strong> quite a while. I could not rest as the<br />
bed hadn't been cleaned up… I was finally taken to<br />
my bed, exhausted, but was then asked to complete<br />
paperwork… it was a very busy night, but I feel this<br />
could perhaps have been handled a bit better”<br />
Mater <strong>Mothers</strong>’ Private Redland 99%<br />
21
Indicator 8: Do care providers treat women with kindness and understanding<br />
Gold standard care is defined as women feeling that they were treated with kindness and understanding ‘all of the time’.<br />
We asked women how frequently the following statement was reflective of their care: “When I saw care providers during my<br />
labour and birth, they treated me with kindness and understanding.” Women could indicate ‘all of the time’, ‘some of the time’ or<br />
‘not at all’.<br />
The graph displays the percentages of women who said that their care providers treated them with kindness and understanding<br />
‘all of the time’, ‘some of the time’ and ‘not at all’.<br />
All of the time Some of the time None of the time<br />
STATEWIDE PUBLIC<br />
83<br />
16<br />
1<br />
Mackay Base <strong>Hospital</strong> (n=95)<br />
80<br />
18<br />
2<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=36)<br />
92<br />
8<br />
STATEWIDE PRIVATE<br />
90<br />
10<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=121)<br />
93<br />
6<br />
1<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Goondiwindi <strong>Hospital</strong> 100%<br />
Longreach <strong>Hospital</strong> 100%<br />
Mareeba <strong>Hospital</strong> 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
Mater <strong>Mothers</strong>’ Private Redland 99%<br />
What do women say about their care<br />
“Staff are very helpful and supportive. While also sensitive<br />
to individual needs and privacy”<br />
“My midwife…was a joy to have very understanding<br />
open-minded and not at all judgmental. Although I didn't<br />
know her or meet her previously I felt I knew her. She<br />
was kind and very on to her job :) and made the whole<br />
family welcome”<br />
“Took way too long to get assistance and one particular<br />
midwife told me my questions about how to wrap my<br />
baby weren't important when other women weren't able<br />
to breastfeed properly and had medical issues.”<br />
22
Indicator 9: Do care providers genuinely care about women’s wellbeing<br />
Gold standard care is defined as women feeling that their care providers genuinely cared about their wellbeing all of the time.<br />
We asked women how frequently the following statement was reflective of their care: “When I saw care providers during my<br />
labour and birth, they genuinely cared about my wellbeing.” Women could indicate ‘all of the time’, ‘some of the time’ or ‘not at<br />
all’.<br />
The graph displays the percentages of women who said that their care providers genuinely cared about their wellbeing ‘all of the<br />
time’, ‘some of the time’ and ‘not at all’.<br />
All of the time Some of the time None of the time<br />
STATEWIDE PUBLIC<br />
84<br />
14<br />
2<br />
Mackay Base <strong>Hospital</strong> (n=94)<br />
90<br />
9<br />
1<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=36)<br />
94<br />
6<br />
STATEWIDE PRIVATE<br />
92<br />
8<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=120)<br />
95<br />
4<br />
1<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Biloela <strong>Hospital</strong> 100%<br />
Goondiwindi <strong>Hospital</strong> 100%<br />
Mareeba <strong>Hospital</strong> 100%<br />
Stanthorpe <strong>Hospital</strong> 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Gold Coast Birth <strong>Centre</strong> 100%<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
Mater <strong>Mothers</strong>’ Private Redland 99%<br />
What do women say about their care<br />
“Everyone treated me with respect and I felt as though<br />
they genuinely cared about my wellbeing. One nurse even<br />
came to visit me the day after I had my daughter when<br />
she wasn't even on shift to say hello and see how I was.”<br />
“A lot of work needs to be done to provide a positive and<br />
supportive environment <strong>for</strong> pregnant women. It is<br />
un<strong>for</strong>tunate that in many instances a woman's experience<br />
is coloured by issues such as patient numbers/ indemnity<br />
insurance/ hospital policy.”<br />
“Lovely staff - kind, caring, gentle & supportive. Prompt<br />
responses to needs <strong>for</strong> pain management.”<br />
23
Indicator 10: Do care providers respect women’s decisions<br />
Gold standard care is defined as women feeling that their care providers respected their decisions all of the time.<br />
We asked women how frequently the following statement was reflective of their care: “When I saw care providers during my<br />
labour and birth, they respected my decisions.” Women could indicate ‘all of the time’, ‘some of the time’ or ‘not at all’.<br />
The graph displays the percentages of women who said their care providers respected their decisions ‘all of the time’, ‘some of<br />
the time’ and ‘not at all’.<br />
All of the time Some of the time None of the time<br />
STATEWIDE PUBLIC<br />
80<br />
17<br />
3<br />
Mackay Base <strong>Hospital</strong> (n=94)<br />
78<br />
19<br />
3<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=36)<br />
86<br />
14<br />
STATEWIDE PRIVATE<br />
89<br />
10<br />
1<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=121)<br />
92<br />
6<br />
2<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Biloela <strong>Hospital</strong> 100%<br />
Mareeba <strong>Hospital</strong> 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
Mater <strong>Mothers</strong>’ Private Redland 97%<br />
What do women say about their care<br />
“The medical staff were great about presenting us with<br />
options and respecting our decision. I was made to feel<br />
welcome, safe, respected and well cared <strong>for</strong> throughout<br />
the process.”<br />
“The emergency doctors didn't care so much <strong>for</strong> my<br />
decisions. I really wanted a natural birth and I feel they<br />
didn't exhaust all options be<strong>for</strong>e going to caesarean.”<br />
“I felt confident that the midwives would assist me with<br />
birthing the way I had planned and that if there were any<br />
complications they would discuss them with me openly.”<br />
24
Part E: Support <strong>for</strong> Consumer Preferences<br />
Women have the right to have their preferences supported and accommodated. Depending on their background, values, culture<br />
or religion, women may have different values and beliefs which may result in different preferences <strong>for</strong> their care during labour and<br />
birth. It is important that care providers be attentive to women’s preferences and use effective communication to ensure that<br />
these needs are respected.<br />
We have reported on five indicators of support <strong>for</strong> women’s preferences.<br />
Indicator 11: Are women’s support people made to feel welcome during labour and birth<br />
Having continuous support during labour has been shown to be associated with less frequent use of analgesia, shorter duration<br />
of labour, increased satisfaction with the birthing experience and less frequent use of instrumental or surgical delivery (Hodnett et<br />
al., 2007). Support people can assist women in a number of ways including the provision of emotional support, pain relief (e.g.<br />
massage, visualisation), and food and drink, and can also act as an advocate <strong>for</strong> women’s preferences <strong>for</strong> birth. Women’s<br />
preferences pertaining to the involvement of their support people should be responded to by care providers.<br />
Indicator 12: Are women’s support people made to feel welcome after birth<br />
Whether their support people will be made to feel welcome is an important consideration <strong>for</strong> women when they are choosing a<br />
birth facility (Thompson & Wojcieszek, under review). The birth of a baby may be a major life event, not only <strong>for</strong> women, but also<br />
<strong>for</strong> their support people. It is important that care providers acknowledge this and ensure that support people are welcomed after<br />
birth, according to women’s preferences, to support bonding and attachment. Support people can also play a valuable role after<br />
birth in assisting women to care <strong>for</strong> both themselves and their babies.<br />
Indicator 13: Can women choose the gender of their care provider(s) <strong>for</strong> labour and birth<br />
Some women, including women from particular cultural backgrounds, may prefer health care providers of the same gender<br />
(<strong>Queensland</strong> Government, 2007a). Based on the Australian Charter of Healthcare Rights, women in receipt of maternity care<br />
services have a right to have their culture, beliefs, values and characteristics respected and acknowledged by care providers<br />
(ACSQHC, 2009). It is important to try to meet these needs as this may help to reduce fear and embarrassment, along with<br />
improving women’s experience of care.<br />
Indicator 14: Do care providers allow women to take their time during labour<br />
To demonstrate truly woman-centred care, women’s individual needs and preferences must be prioritised over the preferences<br />
or agendas of institutions and care providers (ANMC, 2006). Genuine ef<strong>for</strong>ts must to be made to ensure that women receive high<br />
quality of care during labour and birth, regardless of how busy a facility may be at any given point. Interventions aimed at<br />
augmenting the speed of labour should not be per<strong>for</strong>med unless a woman makes a decision to accept such interventions after<br />
being fully in<strong>for</strong>med of the associated outcomes (NICE, 2007).<br />
Indicator 15: Do women feel that their medical procedures were necessary<br />
Use of effective communication is essential <strong>for</strong> ensuring patient preferences are supported and accommodated. According to<br />
the Australian Medical Council, part of communicating effectively with patients is providing adequate in<strong>for</strong>mation about the nature<br />
of, and need <strong>for</strong>, any <strong>for</strong>m of examination or intervention, along with the provision of sufficient time to ask questions or refuse<br />
care (AMC, 2009). Women have a right to make decisions about the treatment they receive (ACSQHC, 2009). As such,<br />
instances where women receive medical procedures that they feel are unnecessary highlight serious deficiencies in the<br />
communication between the care provider and the woman.<br />
25
Indicator 11: Are women’s support people made to feel welcome during labour<br />
and birth<br />
Gold standard care is defined as women feeling that all of their support people are made to feel welcome during labour and birth.<br />
We asked women: “Were all of your support people (e.g. partner, husband, companion) made to feel welcome ... during your<br />
labour...during your birth”<br />
The graph displays the percentages of women who said that all of their support people were made to feel welcome both during<br />
labour and birth. 5<br />
STATEWIDE PUBLIC<br />
94<br />
Mackay Base <strong>Hospital</strong> (n=93)<br />
94<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=35)<br />
100<br />
STATEWIDE PRIVATE<br />
98<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=118)<br />
99<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Atherton <strong>Hospital</strong> 100%<br />
Biloela <strong>Hospital</strong> 100%<br />
Goondiwindi <strong>Hospital</strong> 100%<br />
Gympie <strong>Hospital</strong> 100%<br />
Innisfail <strong>Hospital</strong>* 100%<br />
Kingaroy Health Service 100%<br />
<strong>Proserpine</strong> <strong>Hospital</strong> 100%<br />
Stanthorpe <strong>Hospital</strong> 100%<br />
Best private hospitals in <strong>Queensland</strong>:<br />
Cairns Private <strong>Hospital</strong> 100%<br />
Mater Misericordiae <strong>Hospital</strong> Gladstone 100%<br />
Mater <strong>Mothers</strong>’ Private Redland 100%<br />
Nambour Selangor Private <strong>Hospital</strong> 100%<br />
St Vincent’s <strong>Hospital</strong> Toowoomba 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Gold Coast Birth <strong>Centre</strong> 100%<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Royal Brisbane and Women’s Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
What do women say about their care<br />
“My support people were…made to feel welcome, and at no<br />
time were they asked to leave or made to feel like they were<br />
an intrusion.”<br />
“They made my husband wait outside maternity ward while I<br />
was having contractions. As they were busy, they would not<br />
move me down to birthing, so my husband had to go home<br />
and I was left alone.”<br />
“Midwives were great whilst giving birth, they got my husband<br />
very involved even though neither of us expected that.”<br />
5<br />
For women who did not have a labour, data <strong>for</strong> this indicator are based on whether their support people were made to feel welcome during<br />
birth.<br />
* Denotes a response rate of less than 25%<br />
26
Indicator 12: Are women’s support people made to feel welcome after birth<br />
Gold standard care is defined as women feeling that all of their support people are made to feel welcome after birth.<br />
We asked women: “Were all of your support people (e.g. partner, husband, companion) made to feel welcome ... after your<br />
birth”<br />
The graph displays the percentages of women who said that all of their support people were made to feel welcome after birth. 6<br />
STATEWIDE PUBLIC<br />
95<br />
Mackay Base <strong>Hospital</strong> (n=95)<br />
93<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=35)<br />
100<br />
STATEWIDE PRIVATE<br />
98<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=121)<br />
98<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Biloela <strong>Hospital</strong> 100%<br />
Dalby <strong>Hospital</strong> 100%<br />
Goondiwindi <strong>Hospital</strong> 100%<br />
Kingaroy Health Service 100%<br />
Mt Isa <strong>Hospital</strong>* 100%<br />
<strong>Proserpine</strong> <strong>Hospital</strong> 100%<br />
Stanthorpe <strong>Hospital</strong> 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Gold Coast Birth <strong>Centre</strong> 100%<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospitals in <strong>Queensland</strong>:<br />
Mater Misericordiae <strong>Hospital</strong> Gladstone 100%<br />
Mater <strong>Mothers</strong>’ Private Redland 100%<br />
Sunshine Coast Private <strong>Hospital</strong> 100%<br />
What do women say about their care<br />
“Your partner and family are educated and involved in the birthing<br />
process, and you are able to stay as a family unit once the baby<br />
arrives which helps with bonding.”<br />
“Considering when I gave birth my husband should have been able to<br />
stay, especially as he was fatigued and it was a difficult and traumatic<br />
birth…It was very dangerous <strong>for</strong> him to drive home and he was<br />
<strong>for</strong>ced to by the hospital.”<br />
“Excellent, having your husband stay with you at the hospital made it<br />
all the less stressful and helped create the right environment.”<br />
“I found it really disheartening that I wasn't allowed to have anyone<br />
stay with me the first night. I wasn't able to care <strong>for</strong> my baby as he<br />
was in the special care nursery and I really would have appreciated<br />
the support as I felt quite down.”<br />
“My husband was able to stay at the hospital…after the birth. This<br />
was a huge relief as he was invaluable in helping me to care <strong>for</strong> our<br />
baby after having had a c-section…having him there really cut down<br />
the requirement of the nurses to care <strong>for</strong> me and my baby.”<br />
6<br />
Note, that this does not necessarily include being made to feel welcome overnight.<br />
* Denotes a response rate of less than 25%<br />
27
Indicator 13: Can women choose the gender of their care provider(s) <strong>for</strong> labour<br />
and birth<br />
Gold standard care is defined as women being able to choose the gender of their care provider(s) <strong>for</strong> labour and birth.<br />
We asked women: “Could you choose whether your care provider(s) <strong>for</strong> labour/birth were male or female”<br />
The graph displays the percentage of women who said that they could choose the gender or their care provider(s).<br />
STATEWIDE PUBLIC<br />
10<br />
Mackay Base <strong>Hospital</strong> (n=96)<br />
13<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
7<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=36)<br />
3<br />
STATEWIDE PRIVATE<br />
27<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=122)<br />
34<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Mareeba <strong>Hospital</strong> 29%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Townsville Birth <strong>Centre</strong> 29%<br />
Best private hospital in <strong>Queensland</strong>:<br />
Nambour Selangor Private <strong>Hospital</strong> 36%<br />
What do women say about their care<br />
“My birth plan was not read or ignored as I was given a<br />
male midwife half way through my 22 hour labour. I did not<br />
feel able to object at this painful time… a male student<br />
midwife was also allowed to walk straight up to me and ask<br />
me whilst I was paused between painful and frequent<br />
contractions if he could observe.”<br />
“I also was very uncom<strong>for</strong>table with having males in the<br />
room other than my partner. I made staff aware of this, and<br />
as I started pushing a male paediatrician came into the<br />
room to observe me. I felt this unnecessary as I had no<br />
complication or drugs.”<br />
28
Indicator 14: Do care providers allow women to take their time during labour<br />
Gold standard care is defined as women not feeling that they were rushed or hurried during labour.<br />
We asked women: “Did you feel rushed or hurried by your care provider(s) at any time during your labour”<br />
The graph displays the percentage of women who said that they did not feel rushed or hurried by their care providers at any time<br />
during labour.<br />
STATEWIDE PUBLIC<br />
90<br />
Mackay Base <strong>Hospital</strong> (n=86)<br />
88<br />
Mackay Birth <strong>Centre</strong> (n=14)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=32)<br />
78<br />
STATEWIDE PRIVATE<br />
91<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=93)<br />
94<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Biloela <strong>Hospital</strong> 100%<br />
Dalby <strong>Hospital</strong> 100%<br />
Longreach <strong>Hospital</strong> 100%<br />
Stanthorpe <strong>Hospital</strong> 100%<br />
Warwick <strong>Hospital</strong> 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospital in <strong>Queensland</strong>:<br />
St Andrew’s Ipswich Private <strong>Hospital</strong> 98%<br />
What do women say about their care<br />
“The staff are efficient without compromising on<br />
patient care. It's obvious everybody is busy, but I<br />
never felt rushed.”<br />
“My ob made me feel a little rushed and pressured<br />
into interventions”<br />
“Staff are professional and kind-even though it is a<br />
busy maternity ward, I never felt rushed.”<br />
“I was made to feel like I was a problem <strong>for</strong> them<br />
because I was taking too long to have my baby. I felt<br />
like these midwives didn’t care about me at all.”<br />
29
Indicator 15: Do women feel that their medical procedures were necessary 7<br />
Gold standard care is defined as women feeling that all of the medical procedures during their birth were necessary.<br />
We asked women: “Did you feel the medical procedures during your birth were necessary”<br />
The graph displays the percentage of women who said that they had medical procedures during labour and birth and felt that<br />
‘all’ of the procedures were necessary.<br />
STATEWIDE PUBLIC<br />
80<br />
Mackay Base <strong>Hospital</strong> (n=67)<br />
81<br />
Mackay Birth <strong>Centre</strong> (n=4)<br />
Insufficient data<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=30)<br />
77<br />
STATEWIDE PRIVATE<br />
89<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=94)<br />
95<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Atherton <strong>Hospital</strong> 100%<br />
Biloela <strong>Hospital</strong> 100%<br />
Stanthorpe <strong>Hospital</strong> 100%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Royal Brisbane and Women’s Birth <strong>Centre</strong> 73%<br />
Best private hospital in <strong>Queensland</strong>:<br />
Mater Misericordiae <strong>Hospital</strong> Mackay 95%<br />
What do women say about their care<br />
“I was treated quite badly during the birth. Choices<br />
were made that I felt unnecessary and now have to live<br />
with.”<br />
“The centre is such a homely environment, the<br />
midwives are lovely and make you feel relaxed. There<br />
are no unnecessary examinations and tests.”<br />
“I had an emergency c-section but was not seen by<br />
an OB/GYN who was present <strong>for</strong> it in the days<br />
following while I was in hospital. It was…frustrating<br />
to not have been able to speak to someone who<br />
was actually there to explain fully what happened<br />
and why the c-section was necessary.”<br />
7<br />
Insufficient data <strong>for</strong> Gold Coast Birth <strong>Centre</strong>, Goondiwindi <strong>Hospital</strong>, Mackay Birth <strong>Centre</strong>, Mareeba <strong>Hospital</strong> and Townsville Birth <strong>Centre</strong>.<br />
30
Part F: In<strong>for</strong>med Decision-Making by Consumers<br />
An in<strong>for</strong>med decision is one where the consumer is:<br />
• in<strong>for</strong>med of the potential consequences (pros and cons) of accepting a treatment option and of not accepting that<br />
treatment option, and<br />
• provided with the opportunity to make a decision about subsequent treatment.<br />
The Australian Charter of Healthcare Rights states that “(t)o obtain good health outcomes, it is important <strong>for</strong> patients and<br />
consumers to participate in decisions and choices about their care and health needs” (ACSQHC, 2009). Health care providers<br />
should “(e)ncourage patients and consumers to make fully in<strong>for</strong>med decisions by discussing treatment options available,<br />
including expected outcomes, success rates and incidence of side effects. This includes in<strong>for</strong>ming patients and consumers of<br />
their right to refuse treatment or withdraw consent at any time” (ACSQHC, 2009).<br />
The majority of women (>96%) want to be involved in making decisions about their labour and birth (Brown & Lumley, 1998).<br />
Furthermore, women are significantly more likely to provide positive ratings of intrapartum care when they are involved in making<br />
decisions about their labour and birth care (Brown & Lumley, 1998). Better supporting women and families to make in<strong>for</strong>med<br />
decisions during pregnancy, labour, and birth was identified as a key priority in Re-birthing: The Review of Maternity Services in<br />
<strong>Queensland</strong> (Hirst, 2005).<br />
We have reported on five indicators of consumer in<strong>for</strong>med decision-making.<br />
Indicator 16: Do women make in<strong>for</strong>med decisions about caesarean section<br />
There is evidence from South Australian women, that a considerable proportion feel uninvolved in the decision to have a<br />
caesarean section or feel that they were not given enough in<strong>for</strong>mation about their available options (Turnbull et al., 1999). In<br />
<strong>Queensland</strong>, as in other regions, care providers must give women detailed in<strong>for</strong>mation about the indications <strong>for</strong> a caesarean,<br />
including the risks and benefits of having or not having the procedure, be<strong>for</strong>e seeking their consent (<strong>Queensland</strong> Government,<br />
2011).<br />
Indicator 17: Do women make in<strong>for</strong>med decisions about induction of labour<br />
The <strong>Queensland</strong> Maternity and Neonatal Clinical Guideline on Induction of Labour (IOL) recommends that care providers<br />
“(d)iscuss the risks and benefits of IOL as they pertain to each individual woman to enable the woman to make an in<strong>for</strong>med<br />
decision in consultation with her health care provider” (QMNCGP, 2011).<br />
Indicator 18: Do women make in<strong>for</strong>med decisions about vaginal examinations<br />
Vaginal examinations during labour can be a source of considerable discom<strong>for</strong>t, embarrassment and distress <strong>for</strong> some women<br />
(Lai & Levy, 2002; Lewin et al., 2005). Research findings from the UK identify that many women would have liked more<br />
in<strong>for</strong>mation about intrapartum vaginal examinations and that they did not feel able to refuse the procedure (Lewin et al., 2005). It<br />
is important that women are provided with sufficient, evidence-based in<strong>for</strong>mation about vaginal examinations and offer their<br />
consent <strong>for</strong> the procedure to be carried out (NICE, 2007).<br />
Indicator 19: Do women make in<strong>for</strong>med decisions about fetal monitoring<br />
The <strong>Queensland</strong> Maternity and Neonatal Clinical Guideline on Intrapartum Fetal Surveillance states that “The advantages and<br />
disadvantages of intrapartum fetal surveillance as they pertain to the individual woman should be discussed during pregnancy”<br />
and that a woman should make decisions about fetal monitoring in discussion with her care providers (QMNCGP, 2010).<br />
Indicator 20: Do women make in<strong>for</strong>med decisions about epidural during labour<br />
The In<strong>for</strong>med Consent <strong>for</strong> Invasive Procedures Policy, developed by <strong>Queensland</strong> Health, states women must make an in<strong>for</strong>med<br />
decision to have an epidural <strong>for</strong> pain relief <strong>for</strong> labour (<strong>Queensland</strong> Government, 2007b). As part of this process, women need to<br />
be provided with unbiased in<strong>for</strong>mation on the risks and benefits of the procedure be<strong>for</strong>e being asked to consent to the epidural.<br />
31
Indicator 16: Do women make in<strong>for</strong>med decisions about caesarean section<br />
Gold standard care is defined as women feeling that they made an in<strong>for</strong>med decision to have a caesarean section (that is, the<br />
pros and cons were discussed and they decided from all their available options).<br />
We asked women who had a caesarean section: “Did your maternity care provider(s) discuss with you the pros and cons<br />
(benefits and risks) of having and not having a caesarean” and “Who decided if you would or would not have a caesarean”<br />
Indicator 16.1: Caesarean section scheduled in advance 8<br />
The graph displays the percentage of women who said they made an in<strong>for</strong>med decision to have a caesarean section that was<br />
scheduled in advance (i.e. a caesarean section that was decided on be<strong>for</strong>e women arrived at the hospital to have their baby).<br />
STATEWIDE PUBLIC<br />
51<br />
Mackay Base <strong>Hospital</strong> (n=8)<br />
Insufficient Data<br />
Mackay Birth <strong>Centre</strong> (n=0)<br />
Insufficient Data<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=5)<br />
Insufficient Data<br />
STATEWIDE PRIVATE<br />
53<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=28)<br />
68<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Nambour <strong>Hospital</strong> 73%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Insufficient data<br />
Best private hospital in <strong>Queensland</strong>:<br />
Sunshine Coast Private <strong>Hospital</strong> 71%<br />
What do women say about their care<br />
“I would have liked there to be more in<strong>for</strong>mation about<br />
my choices with a breech baby…I did not like how it<br />
was assumed that I would have a c-section…Even<br />
though it was the best option in the end I would have<br />
liked the in<strong>for</strong>mation presented to me and the decision<br />
be mine and guided by the health care professional.”<br />
“Procedures <strong>for</strong> general anaesthetic <strong>for</strong> caesarean<br />
(catheter inserted while conscious was not explained<br />
to me), very painful and distressing.”<br />
8<br />
Insufficient data <strong>for</strong> Atherton <strong>Hospital</strong>, Biloela <strong>Hospital</strong>, Dalby <strong>Hospital</strong>, Emerald <strong>Hospital</strong>, Gladstone <strong>Hospital</strong>, Gold Coast Birth <strong>Centre</strong>,<br />
Goondiwindi <strong>Hospital</strong>, Gympie <strong>Hospital</strong>, Hervey Bay <strong>Hospital</strong>, Innisfail <strong>Hospital</strong>, Kingaroy Health Service, Longreach <strong>Hospital</strong>, Mackay Base<br />
<strong>Hospital</strong>, Mackay Birth <strong>Centre</strong>, Mareeba <strong>Hospital</strong>, Mater Misericordiae <strong>Hospital</strong> Gladstone, Mt Isa <strong>Hospital</strong>, <strong>Proserpine</strong> <strong>Hospital</strong>, Royal Brisbane<br />
and Women’s Birth <strong>Centre</strong>, Stanthorpe <strong>Hospital</strong>, Townsville Birth <strong>Centre</strong> and Warwick <strong>Hospital</strong>.<br />
32
Indicator 16.2: Caesarean section not scheduled in advance 9<br />
The graph displays the percentage of women who said they made an in<strong>for</strong>med decision to have a caesarean section that was<br />
not scheduled in advance (i.e. a caesarean section that was decided on after women arrived at the hospital to have their baby).<br />
STATEWIDE PUBLIC<br />
17<br />
Mackay Base <strong>Hospital</strong> (n=12)<br />
0<br />
Mackay Birth <strong>Centre</strong> (n=0)<br />
Insufficient data<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=3)<br />
Insufficient data<br />
STATEWIDE PRIVATE<br />
24<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=17)<br />
12<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Rockhampton <strong>Hospital</strong> 35%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Insufficient data<br />
Best private hospital in <strong>Queensland</strong>:<br />
Mater <strong>Mothers</strong>’ Private Redland 31%<br />
What do women say about their care<br />
“The staff were very friendly, open and honest from the<br />
beginning. At no time was I made to feel stupid <strong>for</strong> the<br />
questions I asked, and I was kept well in<strong>for</strong>med at every<br />
stage. My every need was catered to with a smile, and I<br />
never felt like I was inconveniencing anyone. All of my<br />
options were outlined clearly to me, and I was able to be<br />
a major part of every decision made.”<br />
“The OB decided that I would need a c-section and<br />
asked if this was ok. When my partner started to ask a<br />
few questions it became apparent that this was not our<br />
decision at all and we were treated like we should just<br />
be quiet and do what we were told.”<br />
9<br />
Insufficient data <strong>for</strong> Atherton <strong>Hospital</strong>, Biloela <strong>Hospital</strong>, Dalby <strong>Hospital</strong>, Emerald <strong>Hospital</strong>, Gladstone <strong>Hospital</strong>, Gold Coast Birth <strong>Centre</strong>,<br />
Goondiwindi <strong>Hospital</strong>, Gympie <strong>Hospital</strong>, Hervey Bay <strong>Hospital</strong>, Innisfail <strong>Hospital</strong>, Kingaroy Health Service, Longreach <strong>Hospital</strong>, Mackay Birth<br />
<strong>Centre</strong>, Mareeba <strong>Hospital</strong>, Mater Misericordiae <strong>Hospital</strong> Gladstone, Mt Isa <strong>Hospital</strong>, <strong>Proserpine</strong> <strong>Hospital</strong>, Royal Brisbane and Women’s Birth<br />
<strong>Centre</strong>, St Andrew’s Ipswich Private <strong>Hospital</strong>, Stanthorpe <strong>Hospital</strong>, Townsville Birth <strong>Centre</strong> and Warwick <strong>Hospital</strong>.<br />
33
Indicator 17: Do women make in<strong>for</strong>med decisions about induction of labour 10<br />
Gold standard care is defined as women feeling that they made an in<strong>for</strong>med decision to have an induction of labour (that is, the<br />
pros and cons were discussed and they decided from all their available options).<br />
We asked women who had an induction of labour: “Did your maternity care provider(s) discuss with you the pros and cons<br />
(benefits and risks) of being induced and not being induced” and “Who made the decision to induce or not induce you”<br />
The graph displays the percentage of women who said they made an in<strong>for</strong>med decision to have an induction of labour.<br />
STATEWIDE PUBLIC<br />
19<br />
Mackay Base <strong>Hospital</strong> (n=9)<br />
Insufficient data<br />
Mackay Birth <strong>Centre</strong> (n=0)<br />
Insufficient data<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=2)<br />
Insufficient data<br />
STATEWIDE PRIVATE<br />
36<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=27)<br />
52<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Caboolture <strong>Hospital</strong> 39%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Insufficient data<br />
Best private hospital in <strong>Queensland</strong>:<br />
Mater Misericordiae <strong>Hospital</strong> Mackay 52%<br />
Nambour Selangor Private <strong>Hospital</strong> 52%<br />
What do women say about their care<br />
“Staff are amazing everyone genuinely wants<br />
to help you. Every decision is yours to make<br />
without any pressure but with all the facts.”<br />
“I felt pressured by my OBGYN to be induced<br />
and was not aware that being induced meant<br />
I would be stuck in a bed and hooked up to a<br />
drip”<br />
10<br />
Insufficient data <strong>for</strong> Atherton <strong>Hospital</strong>, Biloela <strong>Hospital</strong>, Cairns Private <strong>Hospital</strong>, Dalby <strong>Hospital</strong>, Emerald <strong>Hospital</strong>, Gladstone <strong>Hospital</strong>, Gold<br />
Coast Birth <strong>Centre</strong>, Goondiwindi <strong>Hospital</strong>, Gympie <strong>Hospital</strong>, Hervey Bay <strong>Hospital</strong>, Innisfail <strong>Hospital</strong>, John Flynn Private <strong>Hospital</strong>, Kingaroy Health<br />
Service, Longreach <strong>Hospital</strong>, Mackay Base <strong>Hospital</strong>, Mackay Birth <strong>Centre</strong>, Mareeba <strong>Hospital</strong>, Mater Misericordiae <strong>Hospital</strong> Gladstone, Mt Isa<br />
<strong>Hospital</strong>, <strong>Proserpine</strong> <strong>Hospital</strong>, Royal Brisbane and Women’s Birth <strong>Centre</strong>, St Andrew’s Ipswich Private <strong>Hospital</strong>, Stanthorpe <strong>Hospital</strong>, Townsville<br />
Birth <strong>Centre</strong> and Warwick <strong>Hospital</strong>.<br />
34
Indicator 18: Do women make in<strong>for</strong>med decisions about vaginal examinations 11<br />
Gold standard care is defined as women feeling that they made an in<strong>for</strong>med decision to have vaginal examinations (that is, the<br />
pros and cons were discussed and they decided from all their available options).<br />
We asked women who had at least one vaginal examination: “Did your maternity care provider(s) discuss with you the pros and<br />
cons (benefits and risks) of having and not having vaginal examinations” and “Who made the decision to have or not have<br />
vaginal examinations”<br />
The graph displays the percentage of women who said they made an in<strong>for</strong>med decision to have vaginal examinations during<br />
labour.<br />
STATEWIDE PUBLIC<br />
13<br />
Mackay Base <strong>Hospital</strong> (n=37)<br />
19<br />
Mackay Birth <strong>Centre</strong> (n=1)<br />
Insufficient data<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=16)<br />
0<br />
STATEWIDE PRIVATE<br />
10<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=42)<br />
5<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Caboolture <strong>Hospital</strong> 25%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Royal Brisbane and Women’s Birth <strong>Centre</strong> 40%<br />
Best private hospital in <strong>Queensland</strong>:<br />
John Flynn Private <strong>Hospital</strong> 21%<br />
What do women say about their care<br />
“After I gave birth…the midwife completely violated my<br />
personal space prodding the entrance to my vagina<br />
with her finger apparently to see whether I had torn or<br />
not, causing me extreme pain since I just gave birth<br />
out of there, also minor grazing. She told me what she<br />
was doing just as she touched me so I couldn't say<br />
no.”<br />
“Women should be more in<strong>for</strong>med of their choices by<br />
medical care providers. Once women make an in<strong>for</strong>med<br />
decision this should be respected and encouraged.”<br />
11<br />
Insufficient data <strong>for</strong> Atherton <strong>Hospital</strong>, Biloela <strong>Hospital</strong>, Emerald <strong>Hospital</strong>, Gold Coast Birth <strong>Centre</strong>, Goondiwindi <strong>Hospital</strong>, Gympie <strong>Hospital</strong>,<br />
Innisfail <strong>Hospital</strong>, Longreach <strong>Hospital</strong>, Mackay Birth <strong>Centre</strong>, Mareeba <strong>Hospital</strong>, Stanthorpe <strong>Hospital</strong>, Townsville Birth <strong>Centre</strong> and Warwick<br />
<strong>Hospital</strong>.<br />
35
Indicator 19: Do women make in<strong>for</strong>med decisions about fetal monitoring 12<br />
Gold standard care is defined as women feeling that they made an in<strong>for</strong>med decision about how their baby would be monitored<br />
during labour (that is, the pros and cons were discussed and they decided from all their available options).<br />
We asked women who had fetal monitoring during labour: “Did your maternity care provider(s) discuss with you the pros and<br />
cons (benefits and risks) of monitoring and not monitoring your baby” and “Who made the decision if/how your baby was<br />
monitored”<br />
The graph displays the percentage of women who said they made an in<strong>for</strong>med decision to have fetal monitoring during labour.<br />
STATEWIDE PUBLIC<br />
9<br />
Mackay Base <strong>Hospital</strong> (n=40)<br />
13<br />
Mackay Birth <strong>Centre</strong> (n=7)<br />
Insufficient data<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=19)<br />
5<br />
STATEWIDE PRIVATE<br />
8<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=43)<br />
5<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Caboolture <strong>Hospital</strong> 18%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Royal Brisbane and Women’s Birth <strong>Centre</strong> 32%<br />
Best private hospital in <strong>Queensland</strong>:<br />
Nambour Selangor Private <strong>Hospital</strong> 17%<br />
What do women say about their care<br />
“I was extremely well supported and fully in<strong>for</strong>med. My<br />
decisions were always respected even when they were in<br />
conflict with hospital policies (i.e. continual monitoring was<br />
rejected in early labour).”<br />
“Was very disappointed with the lack of in<strong>for</strong>mation during<br />
labour…On arrival I was given a room put onto a bed and<br />
strapped up to monitors around my belly and was left like<br />
this <strong>for</strong> my whole time in labour at hospital. I was never told<br />
why I was strapped up as there were no complications and<br />
I didn't even know why I wasn't allowed to move as this<br />
made my labour my painful having to stay on the bed.”<br />
12<br />
Insufficient data <strong>for</strong> Atherton <strong>Hospital</strong>, Biloela <strong>Hospital</strong>, Dalby <strong>Hospital</strong>, Gold Coast Birth <strong>Centre</strong>, Goondiwindi <strong>Hospital</strong>, Innisfail <strong>Hospital</strong>,<br />
Mackay Birth <strong>Centre</strong>, Mareeba <strong>Hospital</strong>, Stanthorpe <strong>Hospital</strong>, Townsville Birth <strong>Centre</strong> and Warwick <strong>Hospital</strong>.<br />
36
Indicator 20: Do women make in<strong>for</strong>med decisions about epidural during<br />
labour 13<br />
Gold standard care is defined as women feeling that they made an in<strong>for</strong>med decision about having an epidural (that is, the pros<br />
and cons were discussed and they decided from all their available options).<br />
Of those who had a labour, we asked women who had an epidural: “Did your maternity care provider(s) discuss with you the<br />
pros and cons (benefits and risks) of having and not having an epidural (an injection in your back <strong>for</strong> pain relief) during your<br />
labour” and “Who decided if you would or would not have an epidural during your labour”<br />
The graph displays the proportion of women who had a labour and made an in<strong>for</strong>med decision to have an epidural.<br />
STATEWIDE PUBLIC<br />
65<br />
Mackay Base <strong>Hospital</strong> (n=13)<br />
69<br />
Mackay Birth <strong>Centre</strong> (n=0)<br />
Insufficient data<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=5)<br />
Insufficient data<br />
STATEWIDE PRIVATE<br />
73<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=19)<br />
63<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospital in <strong>Queensland</strong>:<br />
Toowoomba <strong>Hospital</strong> 77%<br />
Best public birth centre in <strong>Queensland</strong>:<br />
Insufficient data<br />
Best private hospital in <strong>Queensland</strong>:<br />
Mater <strong>Mothers</strong>’ Private Redland 100%<br />
What do women say about their care<br />
“I cannot speak highly enough about the care I received in<br />
a midwife base care model where trust was developed<br />
between me and my care providers. I was fully in<strong>for</strong>med<br />
about my options at all times and all of my decisions were<br />
respected. There is a lot to be said about this model of<br />
care and it should be more readily available.”<br />
“I had decided in my birth plan I wanted an epidural. I was<br />
given one however when the midwives changed shifts the<br />
new midwife told me I was no longer allowed to use it.”<br />
13<br />
Insufficient data <strong>for</strong> Atherton <strong>Hospital</strong>, Biloela <strong>Hospital</strong>, Dalby <strong>Hospital</strong>, Emerald <strong>Hospital</strong>, Gladstone <strong>Hospital</strong>, Gold Coast Birth <strong>Centre</strong>,<br />
Goondiwindi <strong>Hospital</strong>, Gympie <strong>Hospital</strong>, Hervey Bay <strong>Hospital</strong>, Innisfail <strong>Hospital</strong>, John Flynn Private <strong>Hospital</strong>, Kingaroy Health Service, Longreach<br />
<strong>Hospital</strong>, Mackay Birth <strong>Centre</strong>, Mareeba <strong>Hospital</strong>, Mater Misericordiae <strong>Hospital</strong> Rockhampton, Mater Misericordiae <strong>Hospital</strong> Gladstone, Mt Isa<br />
<strong>Hospital</strong>, <strong>Proserpine</strong> <strong>Hospital</strong>, Stanthorpe <strong>Hospital</strong>, St Andrew’s Ipswich Private <strong>Hospital</strong>, Townsville Birth <strong>Centre</strong> and Warwick <strong>Hospital</strong>.<br />
37
Part G: Quality of Labour and Birth Rooms<br />
Good quality labour and birth rooms ensure that women’s privacy and dignity are protected and provide a clean, hygienic and<br />
com<strong>for</strong>table environment <strong>for</strong> birth.<br />
We have reported on two indicators of the quality of the labour and birth rooms.<br />
Indicator 21: Was the cleanliness of the labour and birth rooms adequate<br />
Women have a right to receive care in an environment that adheres to high standards of cleanliness and hygiene, to assist in<br />
providing the best outcomes in terms of their health, safety and personal com<strong>for</strong>t.<br />
Indicator 22: Was the privacy of the labour and birth rooms adequate<br />
The right to privacy and confidentiality is one of the core components of the Australian Charter of Healthcare Rights (ACSQHC;<br />
2009). Women have a right to confidentiality in relation to their medical records and health conditions. There<strong>for</strong>e, care providers<br />
have a responsibility to maintain this confidentiality at all times. During labour, birth and after birth, care providers also have a<br />
responsibility to respect women’s privacy within the environment where care is provided. This includes asking <strong>for</strong> permission<br />
be<strong>for</strong>e entering a woman’s room or touching her, providing women with appropriate shielding during examinations or<br />
procedures, and providing detailed explanations of potentially invasive procedures prior to women providing consent.<br />
38
Indicator 21: Was the cleanliness of the labour and birth rooms adequate<br />
Gold standard care is defined as women feeling that the cleanliness of the labour and birth rooms does not need improvement.<br />
We asked: “Were there any aspects of the room <strong>for</strong> labour and birth that needed improvement” Women were asked to select<br />
the aspects of the labour and birth rooms they felt needed improvement from a list including ‘cleanliness’. Women could also<br />
indicate that nothing needed improvement.<br />
The graph displays the percentage of women who did not say that the cleanliness of the labour and birth rooms needed<br />
improvement.<br />
STATEWIDE PUBLIC<br />
97<br />
Mackay Base <strong>Hospital</strong> (n=82)<br />
95<br />
Mackay Birth <strong>Centre</strong> (n=12)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=32)<br />
100<br />
STATEWIDE PRIVATE<br />
99<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=101)<br />
99<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Biloela <strong>Hospital</strong> 100%<br />
Caboolture <strong>Hospital</strong> 100%<br />
Dalby <strong>Hospital</strong> 100%<br />
Emerald <strong>Hospital</strong> 100%<br />
Gladstone <strong>Hospital</strong>* 100%<br />
Goondiwindi <strong>Hospital</strong> 100%<br />
Innisfail <strong>Hospital</strong>* 100%<br />
Mareeba <strong>Hospital</strong> 100%<br />
<strong>Proserpine</strong> <strong>Hospital</strong> 100%<br />
Best private hospitals in <strong>Queensland</strong>:<br />
Cairns Private <strong>Hospital</strong> 100%<br />
Mater Misericordiae <strong>Hospital</strong> Gladstone 100%<br />
Mater Misericordiae <strong>Hospital</strong> Rockhampton 100%<br />
Mater <strong>Mothers</strong>’ Private <strong>Hospital</strong> 100%<br />
Mater <strong>Mothers</strong>’ Private Redland 100%<br />
Nambour Selangor Private <strong>Hospital</strong> 100%<br />
St Andrew’s Ipswich Private <strong>Hospital</strong> 100%<br />
St Vincent’s <strong>Hospital</strong> Toowoomba 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Royal Brisbane and Women’s Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
What do women say about their care<br />
“The birthing suite was very spacious, modern<br />
and very clean.”<br />
“It would have been nice to have my bed sheets<br />
changed at least once during my hospital stay.”<br />
“Private and clean rooms, midwives and nurses<br />
supportive, rooms had relaxing view.”<br />
* Denotes a response rate of less than 25%<br />
39
Indicator 22: Was the privacy of the labour and birth rooms adequate<br />
Gold standard care is defined as women feeling that the privacy of the labour and birth rooms does not need improvement.<br />
We asked: “Were there any aspects of the room <strong>for</strong> labour and birth that needed improvement” Women were asked to select<br />
the aspects of the labour and birth rooms they felt needed improvement from a list including ‘privacy’. Women could also<br />
indicate that nothing needed improvement.<br />
The graph displays the percentage of women who did not say that the privacy of the labour and birth rooms needed<br />
improvement.<br />
STATEWIDE PUBLIC<br />
92<br />
Mackay Base <strong>Hospital</strong> (n=82)<br />
89<br />
Mackay Birth <strong>Centre</strong> (n=12)<br />
100<br />
<strong>Proserpine</strong> <strong>Hospital</strong> (n=32)<br />
94<br />
STATEWIDE PRIVATE<br />
97<br />
Mater Misericordiae <strong>Hospital</strong> Mackay (n=101)<br />
95<br />
0 10 20 30 40 50 60 70 80 90 100<br />
Best public hospitals in <strong>Queensland</strong>:<br />
Biloela <strong>Hospital</strong> 100%<br />
Dalby <strong>Hospital</strong> 100%<br />
Emerald <strong>Hospital</strong> 100%<br />
Goondiwindi <strong>Hospital</strong> 100%<br />
Gympie <strong>Hospital</strong> 100%<br />
Mareeba <strong>Hospital</strong> 100%<br />
Stanthorpe <strong>Hospital</strong> 100%<br />
Best public birth centres in <strong>Queensland</strong>:<br />
Gold Coast Birth <strong>Centre</strong> 100%<br />
Mackay Birth <strong>Centre</strong> 100%<br />
Townsville Birth <strong>Centre</strong> 100%<br />
Best private hospitals in <strong>Queensland</strong>:<br />
Mater Misericordiae <strong>Hospital</strong> Gladstone 100%<br />
Mater <strong>Mothers</strong>’ Private Redland 100%<br />
What do women say about their care<br />
“Wonderful staff that were welcoming and put us<br />
at ease. They gave us privacy when we wanted it<br />
and assisted when asked to.”<br />
“The reason I left hospital after less than 3 days:<br />
No privacy (midwives/doctors never knocked, left<br />
door open while I was changing).”<br />
“All of the staff were extremely helpful and<br />
supportive and friendly but at the same time were<br />
very respectful of your privacy and space.”<br />
“The two way toilet door’s lock was broken which<br />
made <strong>for</strong> some very uncom<strong>for</strong>table intrusions by<br />
myself and the other mum sharing the toilet.”<br />
40
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