Mater Misericordiae Hospital Mackay - Queensland Centre for ...

Consumer Evaluation of Maternity Care Performance in 2010Mater Misericordiae Hospital Mackay

This report was prepared by the Queensland Centre for Mothers & Babies, an independent research centre based at TheUniversity of Queensland and funded by the Queensland Government. The following people contributed to the preparation of thisreport: Yvette D. Miller, Samantha J. Prosser, Rachel Thompson, Aleena M. Wojcieszek, Julie Porter, Ashleigh Armanasco, PeterCoxeter and Sue Kruske.Suggested CitationQueensland Centre for Mothers & Babies. (2012). Consumer Evaluation Report of Maternity Care Performance in 2010: MaterMisericordiae Hospital Mackay. Brisbane, Australia: The University of Queensland.© Copyright The University of Queensland 2012Items may be reproduced free of charge in any format or medium provided that they are not for commercial resale. This consentis subject to the material being reproduced accurately and not used in a derogatory manner or misleading context. The materialshould be acknowledged as © Copyright The University of Queensland 2012 with the title of the document specified.2

ContentsAcknowledgements .................................................................................................................................................................... 5Introduction ................................................................................................................................................................................ 6Background ............................................................................................................................................................................ 6The 2010 Having a Baby in Queensland Survey ...................................................................................................................... 6About This Report ................................................................................................................................................................... 6Using this Report for Quality Improvement ............................................................................................................................... 7Finding Out More .................................................................................................................................................................... 7Statewide Snapshot ................................................................................................................................................................... 8Response Rate ....................................................................................................................................................................... 8Representativeness of Respondents ....................................................................................................................................... 9Performance Summary: Mater Misericordiae Hospital Mackay .................................................................................................. 10Part A: Quality of Interpersonal Care ......................................................................................................................................... 11Indicator 1: How well are women looked after at this facility? ................................................................................................. 12Indicator 2: Would women recommend this facility to a friend? .............................................................................................. 13Part B: Access to Care ............................................................................................................................................................. 14Indicator 3: Do women have a booking appointment by 18 weeks’ gestation? ...................................................................... 15Indicator 4: Do women receive a home visit or telephone call within 10 days of discharge? ................................................... 16Part C: Attention from Care Providers ....................................................................................................................................... 17Indicator 5: Do women have continuity of carer during labour and birth? ............................................................................... 18Indicator 6: Are women satisfied with the amount of care during their postnatal stay? ........................................................... 19Part D: Respectful Care ............................................................................................................................................................ 20Indicator 7: Do care providers treat women with respect? ..................................................................................................... 21Indicator 8: Do care providers treat women with kindness and understanding? ..................................................................... 22Indicator 9: Do care providers genuinely care about women’s wellbeing? .............................................................................. 23Indicator 10: Do care providers respect women’s decisions? ................................................................................................ 24Part E: Support for Consumer Preferences ............................................................................................................................... 25Indicator 11: Are women’s support people made to feel welcome during labour and birth? ................................................... 26Indicator 12: Are women’s support people made to feel welcome after birth? ....................................................................... 27Indicator 13: Can women choose the gender of their care provider(s) for labour and birth? .................................................... 28Indicator 14: Do care providers allow women to take their time during labour? ...................................................................... 29Indicator 15: Do women feel that their medical procedures were necessary? ......................................................................... 30Part F: Informed Decision-Making by Consumers ...................................................................................................................... 31Indicator 16: Do women make informed decisions about caesarean section? ........................................................................ 32Indicator 16.1: Caesarean section scheduled in advance ................................................................................................... 32Indicator 16.2: Caesarean section not scheduled in advance ............................................................................................. 33Indicator 17: Do women make informed decisions about induction of labour? ....................................................................... 34Indicator 18: Do women make informed decisions about vaginal examinations? .................................................................... 35Indicator 19: Do women make informed decisions about fetal monitoring? ............................................................................ 36Indicator 20: Do women make informed decisions about epidural during labour? .................................................................. 373

Part G: Quality of Labour and Birth Rooms ............................................................................................................................... 38Indicator 21: Was the cleanliness of the labour and birth rooms adequate? ........................................................................... 39Indicator 22: Was the privacy of the labour and birth rooms adequate? ................................................................................. 40References ............................................................................................................................................................................... 414

AcknowledgementsWomen who participated in the Having a Baby in Queensland 2010 Survey generously offered to share their experiences ofmaternity care in Queensland. Without their valuable perspectives, evaluation of services from a consumer perspective to informquality improvement efforts would not be possible.The Queensland Registry of Births, Deaths and Marriages contacted women to invite them to participate and were committed toensuring women’s privacy was protected throughout the process.The Having a Baby in Queensland Survey Program was established by Yvette Miller, Rachel Thompson and Christina Lee. YvetteMiller, Samantha Prosser, Rachel Thompson, Aleena Wojcieszek, Julie Porter and Ashleigh Armanasco developed the 2010survey instrument, data collection methods and development of performance indicators on which this report is based. SamanthaProsser conducted the data analysis for this report. The design of this report was developed by Yvette Miller and Hazel Brittain inconsultation with Kirstine Sketcher-Baker, David Park and Kew Walker from the Centre for Healthcare Improvement (formerlyClinical Practice Improvement Centre) and Kerry Ann Ungerer from the Primary, Community and Extended Care Branch,Queensland Health.Queensland Health provides ongoing support to the Queensland Centre for Mothers & Babies in their work towards maternitycare reform in Queensland. The Having a Baby in Queensland Survey Program is funded by the Queensland Government.5

IntroductionBackgroundThe Queensland Centre for Mothers & Babies (QCMB) is an independent research centre based at The University of Queensland.The Centre was funded by the Queensland Government in 2009, in response to the findings of the Review of Maternity Servicesin Queensland (Hirst, 2005). A key strategic direction of the Centre is to generate and disseminate evidence that enhances thecapacity of care providers and policy-makers to understand, and respond to, the requirements of women accessing maternitycare.To meet this goal, the QCMB conducts population surveys to understand the maternity care experiences of women inQueensland. The surveys ask women about the care and support they received before, during and after the birth of their mostrecent baby. The surveys are an important way of collecting women’s perspectives on the quality of maternity services providedin Queensland.The 2010 Having a Baby in Queensland SurveyIn 2010, all women who had a live birth in Queensland between February 1 and May 30, received a Having a Baby in QueenslandSurvey package in the mail when their baby was 4 to 5 months old. Three modes of survey completion were available to women:paper, online or telephone. Women were also given the option to complete the survey in a language other than English over thetelephone, with a translator and a female interviewer (see Miller et al., 2011 for more information).Data collected in the Having a Baby in Queensland Survey Program are used in several ways. Data are provided directly toQueensland Health in a comprehensive report outlining key survey findings. This report highlights differences in consumerexperiences based on health sector, parity, and rurality of residence, in addition to providing recommendations for improvedservice delivery. An electronic copy of the report is available at www.qcmb.org.au/reports. Data are also presented in Birthplace,an online consumer guide to all birthing facilities in Queensland (www.havingababy.org.au/birthplace) 1 . Birthplace was developedto support women and their families to choose a facility for birth and/or to know what to expect from their chosen birthing facility.Birthplace can also be used by care providers and others for quality improvement purposes, and some facility-level data notincluded in this report can be viewed in Birthplace.About This ReportThis report presents the findings of the 2010 Having a Baby in Queensland Survey at an individual facility level. The report wasdeveloped as a means of providing feedback on the experiences of consumers to facilities, particularly by identifying areas ofstrength and opportunities for improvement in service delivery. We have selected 22 key performance indicators to highlight thecare provided to women in each geographic region in Queensland. Rather than reporting on clinical indicators that may differaccording to the case mix in a particular facility, indicators were selected based on their applicability to all women.On each performance indicator we provide the proportion of respondents from each birth facility within that region who reportedreceiving ‘gold standard care’. Gold standard care is always represented by the red bars in the graph. For some indicators (e.g.being well cared for, being treated with respect), gold standard care is achieved where women give their care the highestevaluation possible. Where data are measured on a continuous scale of 1 (lowest) to 5 (highest), gold standard care is achievedfor 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 ofthe time’), gold standard care is achieved for all women who report ‘all of the time’. We report on gold standard care as it isexpected that care providers would strive for all women in the birth facility to receive the highest level of care possible for suchindicators.For other indicators (e.g. timing of booking visit, postnatal contact), gold standard care is achieved where women report anexperience that is consistent with current Queensland Health policies and guidelines and/or research evidence on best carepractices. Again, we report on gold standard care as it is expected that care providers would strive for all women in the birthfacility to report care consistent with current policies, guidelines and research evidence.1In some instances, the figures presented in this report may differ by 1% from those reported in Birthplace due to differential approaches forrounding decimal places between the two systems.6

Where the total number of respondents from any facility is less than 10 on a given performance indicator, data are not reportedat a facility level to protect respondents’ anonymity. For this reason, it was not possible to report on any indicators for thefollowing facilities: Ayr Hospital, Charleville Hospital, Charters Towers Health Centre, Chinchilla Health Service, CunnamullaHospital, Roma Hospital, St George Hospital, Theodore Hospital, Thursday Island Hospital, Toowoomba Birth Centre, and TullyHospital. Responses from women who gave birth in these facilities are included in the statewide public statistics presented in thisreport as this was not seen to compromise their anonymity.When reporting 2010 survey data for a consumer audience through the facility level tool, ‘Birthplace’(www.havingababy.org.au/birthplace), an additional quality assurance measure is used in that we do not report data on facilitieswhere fewer than 25% of women who birthed in that facility in the survey period responded. This measure was adopted toprovide greater confidence in the representativeness of facility-specific data. However, given that the purpose of this report is toprovide feedback to facilities for quality improvement purposes, data from facilities where fewer than 25% of women who birthedin the survey period responded to the survey have been retained. Where such data are reported, an asterisk (*) is provided at theend of the facility name. Where a category on any given indicator was less than 1%, this has not been reported in the graphs.Using this Report for Quality Improvement‘Areas of highest performance’ are those indicators for which the largest proportion of respondents reported receiving goldstandard care in this facility. ‘Areas of lowest performance’ are those indicators for which the smallest proportion ofrespondents reported receiving gold standard care in this facility. Together, these indicators highlight areas of strength in careprovision (optimal performance) and areas needing improvement (weakest performance) to inform priorities for qualityimprovement.The ‘best facility’ attributions for each performance indicator are provided for facilities in each category (public hospitals, publicbirth centres and private hospitals) across Queensland for whom the largest proportion of respondents reported receiving goldstandard care. These facilities provide some indication of readily achievable levels of performance on each indicator and mayprovide opportunities for learning from identified models of best practice for quality improvement efforts.The ‘What do women say about their care?’ sections provide illustrative examples of women’s reports of positive andnegative experiences of care and can be used to guide quality improvement. To ensure women’s privacy, these quotes areprovided from women across Queensland and are not specific to the individual facility named in the report or to those facilitiesidentified as demonstrating best performance.It may also be helpful to review a facility’s performance against similar facilities in Queensland that are outside of this geographicregion. Copies of the Consumer Evaluations of Maternity Care Performance reports are available for all reportable birth facilities inQueensland (i.e. where the number of survey respondents for a given facility is greater than or equal to 10 women) online atwww.qcmb.org.au/facilityreports.Finding Out MoreIn addition to the Consumer Evaluations of Maternity Care Performance reports for other birth facilities, some of the data includedin this report, and additional facility-level data not included in this report, can be viewed in Birthplace(www.havingabay.org.au/birthplace).To contact the Queensland Centre for Mothers & Babies, please call (07) 3346 8797 or email info@qcmb.org.au. Further detailsabout the work of the centre are also provided online at www.qcmb.org.au7

Statewide SnapshotResponse RatePublic Hospitals and Birth CentresThe number and percentage of women who provided responses to the 2010 Having a Baby in Queensland Survey for eachpublic hospital and birth centre are provided below.Number of respondents Response rateAtherton Hospital 25 35%Ayr Hospital 9 18%Biloela Hospital 12 39%Bundaberg Hospital 126 30%Caboolture Hospital 213 30%Cairns Base Hospital 212 24%Charleville Hospital 7 44%Charters Towers Health Centre 2 29%Chinchilla Health Service 8 47%Cunnamulla Hospital 1 25%Dalby Hospital 28 31%Emerald Hospital 29 33%Gladstone Hospital 41 24%Gold Coast Hospital 343 31%Gold Coast Birth Centre 28 56%Goondiwindi Hospital 12 27%Gympie Hospital 33 30%Hervey Bay Hospital 90 25%Innisfail Hospital 18 16%Ipswich Hospital 206 24%Kingaroy Health Service 40 28%Logan Hospital 266 23%Longreach Hospital 18 38%Mackay Base Hospital 96 25%Mackay Birth Centre 14 78%Mareeba Hospital 14 30%Mater Mothers’ Public Hospital 488 30%Mt Isa Hospital 36 19%Nambour Hospital 231 32%Proserpine Hospital 36 42%Redcliffe Hospital 136 28%Redland Hospital 222 33%Rockhampton Hospital 114 25%Roma Hospital 5 16%Royal Brisbane and Women’s Hospital 451 33%Royal Brisbane and Women’s Birth Centre 78 70%St George Hospital 5 23%Stanthorpe Hospital 16 29%Theodore Hospital 4 33%Thursday Island Hospital 3 5%Toowoomba Hospital 200 30%Townsville Hospital 148 21%Townsville Birth Centre 21 75%Tully Hospital 0 0%Warwick Hospital 18 30%STATEWIDE PUBLIC HOSPITALS AND BIRTH CENTRES 4,124 29%8

Private HospitalsThe number and percentage of women who provided responses to the 2010 Having a Baby in Queensland Survey for eachprivate hospital are provided below.Number of respondents Response rateCairns Private Hospital 93 41%John Flynn Private Hospital 108 42%Mater Misericordiae Hospital Gladstone 34 46%Mater Misericordiae Hospital Mackay 122 45%Mater Misericordiae Hospital Rockhampton 110 47%Mater Women’s and Children’s Hospital Townsville 146 41%Mater Mothers’ Private Hospital (South Brisbane) 761 49%Mater Mothers’ Private Redland 68 46%Nambour Selangor Private Hospital 148 48%North West Private Hospital 297 48%Pindara Private Hospital 242 43%St Andrew’s Ipswich Private Hospital 68 50%St Vincent’s Hospital Toowoomba 175 44%Sunnybank Private Hospital 190 41%Sunshine Coast Private Hospital 83 51%Wesley Private Hospital 283 48%STATEWIDE PRIVATE HOSPITALS 2,935 46%Representativeness of RespondentsThe survey respondents include women who had live births (single and multiple births) in Queensland between February 1 andMay 30, 2010. The representativeness of survey respondents was compared with population statistics reported for women whogave birth in Queensland in 2008 (based on Australia’s Mothers and Babies, and Perinatal Statistics Queensland) on several keyindices 2 . It is important to note that these comparisons provide an estimate only of sample representativeness given thatpopulation statistics are not yet publically available for women who gave birth in 2010. Additionally, the 2008 populationstatistics include women who experienced a stillbirth or a neonatal death, however these women are not included in the Having aBaby in Queensland data presented in this report.Relative to the women who gave birth in Queensland in 2008 (Laws et al., 2010; Queensland Health, 2010), the respondentsample under-represented the following groups:− Multiparous women (54.6% in the respondent sample vs. 60.0% of all birthing women in Queensland)− Aboriginal and/or Torres Strait Islander women (1.7% in the respondent sample vs. 5.6% of all Queensland birthingwomen)− Younger women (aged

Performance Summary: Mater Misericordiae Hospital MackayThe list below provides a summary of performance for Mater Misericordiae Hospital Mackay based on the 22 indicators selectedfor this report. Indicators are ordered from highest to lowest in terms of the proportion of women who received gold standardcare at Mater Misericordiae Hospital Mackay.Indicator 11: Are women’s support people made to feel welcome during labour and birth? 99%Areas ofhighestperformance:Indicator 21: Was the cleanliness of the labour and birth rooms adequate? 99%Indicator 12: Are women’s support people made to feel welcome after birth? 98%Indicator 2: Would women recommend this facility to a friend? 95%Indicator 9: Do care providers genuinely care about women’s wellbeing? 95%Indicator 15: Do women feel that their medical procedures were necessary? 95%Indicator 22: Was the privacy of the labour and birth rooms adequate? 95%Indicator 7: Do care providers treat women with respect? 94%Indicator 14: Do care providers allow women to take their time during labour? 94%Indicator 6: Are women satisfied with the amount of care during their postnatal stay? 93%Indicator 8: Do care providers treat women with kindness and understanding? 93%Indicator 10: Do care providers respect women’s decisions? 92%Indicator 5: Do women have continuity of carer during labour and birth? 89%Indicator 1: How well are women looked after at this facility? 84%Indicator 16.1:Do women make informed decisions about caesarean sections scheduled inadvance?Indicator 20: Do women make informed decisions about epidural during labour? 63%Indicator 17: Do women make informed decisions about induction of labour? 52%68%Indicator 4: Do women receive a home visit or telephone call within 10 days of discharge? 35%Indicator 13: Can women choose the gender of their care provider(s) for labour and birth? 34%Indicator 3: Do women have a booking appointment by 18 weeks’ gestation? 17%Areas of lowestperformance:Indicator 16.2:Do women make informed decisions about caesarean sections not scheduled inadvance?Indicator 18: Do women make informed decisions about vaginal examinations? 5%12%Indicator 19: Do women make informed decisions about fetal monitoring? 5%10

Part A: Quality of Interpersonal CareQuality of interpersonal care reflects an overall assessment of the standard of non-clinical care received from the perspective ofthe consumer. While the quality of clinical care is regularly recorded and reported on, the quality of interpersonal care and patientexperience is assessed far less frequently. It is important that aspects of interpersonal care are assessed as these factors areassociated with patient satisfaction and overall engagement with health services (Watson & Gallois, 2007).We have reported on two indicators of the quality of interpersonal care.Indicator 1: How well are women looked after at this facility?The safety and quality of maternity care in Queensland are currently monitored via a number of different mechanisms atorganisational, district, and state-wide levels. Maternity care consumer assessments of the overall standard of interpersonal careare critical to complement existing measures of the safety and quality of maternity care in Queensland.Indicator 2: Would women recommend this facility to a friend?Whether a patient would recommend their care provider, health facility, or treatment, is a reliable and widely used indicator of apositive experience of care (Dodd et al., 2004; Halfon et al., 2004; Murray-Davis et al., 2012). As such, recommending their birthfacility to a friend is a good reflection of how favourably women view their chosen birth facility.11

Indicator 1: How well are women looked after at this facility?Gold standard care is defined as women feeling that they were looked after ‘very well’ during labour and birth. As such, bestfacilities are those where the highest percentage of women said that they were looked after ‘very well’ during labour and birth.We asked: “Overall, how well were you looked after by your care provider(s) during labour and birth?”The graph displays the percentage of women who said that they were looked after ‘very well’ (‘5’), as well as the percentages ofwomen who gave a rating of ‘4’, ‘3’, ‘2’ and ‘1’ (‘very badly’) on the same scale.5 = Very well 4 3 2 1 = Very badlySTATEWIDE PUBLIC632493 1Mackay Base Hospital (n=96)5628113 2Mackay Birth Centre (n=14)100Proserpine Hospital (n=36)73198STATEWIDE PRIVATE80173Mater Misericordiae Hospital Mackay (n=119)84123 10 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Mareeba Hospital 93%Best public birth centres in Queensland:Mackay Birth Centre 100%Townsville Birth Centre 100%Best private hospital in Queensland:John Flynn Private Hospital 89%What do women say about their care?“The midwives and obstetricians work together toprovide individual care to the parents during labour &the baby afterwards. The hospital is like a home.Lovely experience utmost respect is given to parentdecisions. We felt very safe.”“My largest disappointment about having my baby,was the lack of choices and options I was given at alltimes during my pregnancy and labour. I was reallytreated as a number. It was all very impersonal. Mybirth plan was disregarded by all staff.”12

Indicator 2: Would women recommend this facility to a friend?Gold standard care is defined as women feeling that they would recommend the hospital or birth centre to a friend.We asked: “Would you recommend this hospital or birth centre to a friend?”The graph displays the percentage of women who said that they would recommend their hospital or birth centre to a friend.STATEWIDE PUBLIC91Mackay Base Hospital (n=94)90Mackay Birth Centre (n=14)100Proserpine Hospital (n=36)97STATEWIDE PRIVATE96Mater Misericordiae Hospital Mackay (n=122)950 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Dalby Hospital 100%Emerald Hospital 100%Goondiwindi Hospital 100%Innisfail Hospital* 100%Mareeba Hospital 100%Best public birth centres in Queensland:Gold Coast Birth Centre 100%Mackay Birth Centre 100%Royal Brisbane and Women’s Birth Centre 100%Townsville Birth Centre 100%Best private hospital in Queensland:Mater Misericordiae Hospital Gladstone 100%What do women say about their care?“The staff were very helpful and caring. The help withbreastfeeding was wonderful and I would recommend[facility name] to everyone.”“The labour and birth care is good; do not recommendthe aftercare though”“They treated me and my husband very good andrespected any decisions we made. I couldn'trecommend the hospital highly enough.”“They [the midwives] are nasty and unprofessional…Ifelt really uncomfortable…Really bad communicationbetween doctors, midwives and other nurses…It seemschaos and confusion reigned…I would neverrecommend the hospital.”* Denotes a response rate of less than 25%13

Part B: Access to CareAccess to care focuses specifically on the availability and provision of antenatal and postnatal care. Access to care performanceindicators were derived from Queensland Health targets for best practice including targets for early initiation of antenatal care andestablishing Universal Postnatal Contact following hospital discharge.We have reported on two indicators of access to care.Indicator 3: Do women have a booking appointment by 18 weeks’ gestation?Earlier initiation of contact with health care professionals during pregnancy has been shown to affect maternal and infantpostnatal outcomes (Villar et al., 2001). According to the Queensland Health Recommended Minimum Antenatal Schedule, amidwife booking-in visit should occur between 12 and 18 weeks’ gestation (Queensland Government, 2010a). The RoyalAustralian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) also advocates for early initiation ofmaternity care and proposes that booking appointments should ideally occur by 12 weeks gestation (RANZCOG, 2011).Indicator 4: Do women receive a home visit or telephone call within 10 days of discharge?The Universal Postnatal Contact Initiative identified goals for ensuring all maternity care consumers receive follow-up contact(either by telephone or by home visit) after hospital discharge (Queensland Government, 2010b). This initiative aims to improveintegration of maternity care between hospital and community health services for women and their babies.14

Indicator 3: Do women have a booking appointment by 18 weeks’ gestation?Gold standard care is defined as women having a booking appointment by 18 weeks’ gestation.We asked: “How many weeks pregnant were you when you had your ‘booking’ appointment?” 4The graph displays the percentage of women who said that they had a booking appointment by 18 weeks’ gestation.STATEWIDE PUBLIC69Mackay Base Hospital (n=86)70Mackay Birth Centre (n=13)77Proserpine Hospital (n=35)23STATEWIDE PRIVATE57Mater Misericordiae Hospital Mackay (n=111)170 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Redland Hospital 88%Best public birth centre in Queensland:Gold Coast Birth Centre 85%What do women say about their care?“Found [facility name] staff very welcoming and supportiveof all decisions. I was really impressed with the attention todetail they went through on the first appointment, themidwife went through the PHR book and asked all familyhistory etc. questions, rather than filing it out myself as Ihad to do for previous pregnancy elsewhere.”“Prepare yourself for long waits for your appointment andnever expect to see the same person twice”Best private hospital in Queensland:North West Private Hospital 90%“I felt a bit rushed on both appointments during mypregnancy”4This data was collected in relation to women’s planned place of birth rather than their actual place of birth. Only a small proportion of womensampled (less than 5%) indicated that their baby was not born at their planned place of birth. This proportion includes babies who were bornbefore arrival.15

Indicator 4: Do women receive a home visit or telephone call within 10 days ofdischarge?According to the Queensland Health Universal Postnatal Contact Initiative, gold standard care is defined as women beingcontacted by a care provider (either by telephone or by home visit) within 7-10 days of discharge from hospital.We asked: “In the first 10 days of being at home with your baby, did any of the following happen...?” Women could indicate thatthey were telephoned by a midwife or nurse and/or received a home visit from a midwife or nurse, or that they were notcontacted by a midwife or nurse.The graph displays the percentage of women who said they were telephoned by a midwife or nurse and/or received a home visitfrom a midwife or nurse, as well as the percentage of women who received neither a telephone call nor a home visit, in the first10 days of being at home. Three shades of red are used in the graph to represent the different types of gold standard carereported by women.Visit and call Visit only Call only Neither visit nor callSTATEWIDE PUBLIC37301914Mackay Base Hospital (n=96)4828168Mackay Birth Centre (n=14)651421Proserpine Hospital (n=36)3364714STATEWIDE PRIVATE251578Mater Misericordiae Hospital Mackay (n=121)2 231650 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Redcliffe Hospital 99%Best public birth centres in Queensland:Gold Coast Birth Centre 100%Mackay Birth Centre 100%Townsville Birth Centre 100%Best private hospital in Queensland:North West Private Hospital 63%What do women say about their care?“The pre and post birth support (midwife visits to yourhome for up to six weeks following bub’s arrival) meantthat we have experienced a completely smooth andhappy transition of our bub into our lives and home. Theguidance and support provided by [model of care] duringthe pregnancy and post birth left us confident and ablefirst time parents”“I wish I had more access to aftercare for my baby…Achild health care nurse that you could contact, go andsee or have visit me in my own home. May have helpedsettle my new baby quicker, in that I would have hadanswers sooner.”16

Part C: Attention from Care ProvidersAttention from care providers refers to the nature of contact with maternity care providers women have during labour, birth andthe postnatal stay in hospital. Having sufficient contact between women and care providers is important for building rapport,ensuring consistent provision of care and information, and aiding early detection of potential maternal or infant health needs orrisks.We have reported on two indicators of attention from care providers.Indicator 5: Do women have continuity of carer during labour and birth?Having continuity of carer during labour and birth (i.e. having at least one individual care provider who remains caring for awoman throughout her labour and birth) is highly valued by maternity care consumers in Queensland (Thompson & Wojcieszek,under review).Indicator 6: Are women satisfied with the amount of care during their postnatal stay?Care received during the postnatal stay has been rated less favourably by women in other Australian states than the carereceived during pregnancy, labour and birth (Brown et al., 2005). It is important that women are adequately supported during thistime, particularly given the number of transitions that may be occurring in addition to being in an unfamiliar environment. Thepreferred amount and frequency of support during a postnatal stay may vary across women depending on their individualcircumstances, thus it is important for care providers to be attentive and communicate effectively with women to ensure they arereceiving the right level of attention.17

Indicator 5: Do women have continuity of carer during labour and birth?Gold standard care is defined as women having at least one maternity care provider (i.e., the same person) care for them rightthrough labour and birth (or through birth for women who do not have labour).We asked: “Was there at least one maternity care provider who cared for you right through your labour/birth?”The graph displays the percentage of women who said they had at least one care provider who cared for them right throughlabour and birth.STATEWIDE PUBLIC69Mackay Base Hospital (n=92)67Mackay Birth Centre (n=14)86Proserpine Hospital (n=35)71STATEWIDE PRIVATE86Mater Misericordiae Hospital Mackay (n=122)890 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Mareeba Hospital 100%Best public birth centre in Queensland:Gold Coast Birth Centre 100%Best private hospital in Queensland:Wesley Private Hospital 94%What do women say about their care?“I had a single midwife who cared for me throughout my pregnancy,labour/birth and for 6 weeks after the birth. I felt comfortableknowing that I could contact her at any time if I had concerns, and Iknew that she would always talk with me in a genuine, honest andrespectful manner…I felt comfortable and safe in her care and knewthat she was aware of my wishes and concerns relating to the birthand felt that I could completely trust her.”“I had a change of 4 midwives through my last stages of labour,personally speaking it was very unsettling having midwives exchangenotes mid-way and having go through introductions of your newmidwives whilst in pain.”“Constantly seeing 'stand in' midwives meant I did not receiveconsistent or adequate care and advice.”18

Indicator 6: Are women satisfied with the amount of care during their postnatalstay?Gold standard care is defined as women feeling that the amount they were checked on by their care provider(s) during thepostnatal stay was ‘about right’.We asked: “Thinking about how often a care provider came and ‘checked’ on you during your stay in the hospital or birth centre,was this... about right? not often enough? too often?”The graph displays the proportion of women who said that the amount their care provider(s) checked on them was ‘about right’,‘not often enough’ and ‘too often’, during their postnatal stay.About right Not often enough Too oftenSTATEWIDE PUBLIC74233Mackay Base Hospital (n=95)8317Mackay Birth Centre (n=14)937Proserpine Hospital (n=36)7525STATEWIDE PRIVATE86113Mater Misericordiae Hospital Mackay (n=122)9370 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Innisfail Hospital* 94%Best public birth centre in Queensland:Townsville Birth Centre 100%Best private hospital in Queensland:Mater Misericordiae Hospital Mackay 93%Mater Mothers’ Private Redland 93%What do women say about their care?“All of the staff were extremely helpful and supportiveand friendly but at the same time were veryrespectful of your privacy and space. I always feltthat they were there for myself or my baby if Ineeded them day or night.”“Labour and birth good. After care, not so good.Staff too busy, not enough of them.”* Denotes a response rate of less than 25%19

Part D: Respectful CareRespectful care includes treating women with dignity, courtesy, kindness and understanding. Respectful care acknowledgeswomen’s individuality, reflects genuine care for their wellbeing, and allows them the time they need to make decisions. In anattempt to avoid typically high and less useful global ratings of health care, researchers have begun to move away from theconcept of patient satisfaction and focus on more useful specific patient experiences of care (Wiegers, 2009).We have reported on four indicators of respectful care.Indicator 7: Do care providers treat women with respect?The Australian Charter of Healthcare Rights highlights that “patients and consumers have a right to receive care in a manner thatis respectful of their culture, beliefs, values and characteristics like age and gender” (ACSQHC, 2009). Women in receipt ofmaternity care services have a right to be treated with dignity and consideration by their care providers. The Code of GoodMedical Practice states that “good medical practice involves treating your patients with respect at all times” (AMC, 2009), whichcan be used as a target for delivering gold standard care.Indicator 8: Do care providers treat women with kindness and understanding?To provide holistic care during labour and birth, care providers should ensure that women’s needs are met both physically andpsychologically (ANMC, 2006). Having a care provider who demonstrates support and compassion is rated very highly bywomen as contributing to a positive experience of labour and birth (Lavender et al., 1999).Indicator 9: Do care providers genuinely care about women’s wellbeing?Woman-centred care is care that prioritises the needs and preferences of each individual woman over the needs of careproviders, facilities and the maternity care system. Demonstrating genuine care for women’s wellbeing can be seen as acomponent of delivering care that is genuinely woman-centred.Indicator 10: Do care providers respect women’s decisions?The Australian Medical Council supports the view that in order to deliver good patient care, care providers must respect andrecognise that patients have a right to make their own decisions about their care (AMC, 2009). While care providers have aresponsibility to provide unbiased information about all available options, the final decision in any given situation ultimatelyremains at the discretion of the patient. Part of respecting a woman in maternity care is also respecting her ability to makedecisions that are best suited to her individual needs and circumstances.20

Indicator 7: Do care providers treat women with respect?Gold standard care is defined as women feeling that they were treated with respect ‘all of the time’.We asked women how frequently the following statement was reflective of their care: “When I saw care providers during mylabour and birth, they treated me with respect.” Women could indicate ‘all of the time’, ‘some of the time’ or ‘not at all’.The graph displays the percentages of women who said that their care providers treated them with respect ‘all of the time’,‘some of the time’ and ‘not at all’.All of the time Some of the time Not at allSTATEWIDE PUBLIC85141Mackay Base Hospital (n=95)82171Mackay Birth Centre (n=14)100Proserpine Hospital (n=36)973STATEWIDE PRIVATE937Mater Misericordiae Hospital Mackay (n=121)9460 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Goondiwindi Hospital 100%Longreach Hospital 100%Mareeba Hospital 100%Stanthorpe Hospital 100%Best public birth centres in Queensland:Gold Coast Birth Centre 100%Mackay Birth Centre 100%Townsville Birth Centre 100%Best private hospital in Queensland:What do women say about their care?“The midwife team never used fear as a motivatorbut operated from a positive focus to achieve thebest outcome for both me and my baby. It was sucha positive experience and I felt safe, respected andsupported throughout the labour/birth this to me isthe best way to have a baby.”“After delivery and my shower, I had to wait in thedelivery room for quite a while. I could not rest as thebed hadn't been cleaned up… I was finally taken tomy bed, exhausted, but was then asked to completepaperwork… it was a very busy night, but I feel thiscould perhaps have been handled a bit better”Mater Mothers’ Private Redland 99%21

Indicator 8: Do care providers treat women with kindness and understanding?Gold standard care is defined as women feeling that they were treated with kindness and understanding ‘all of the time’.We asked women how frequently the following statement was reflective of their care: “When I saw care providers during mylabour and birth, they treated me with kindness and understanding.” Women could indicate ‘all of the time’, ‘some of the time’ or‘not at all’.The graph displays the percentages of women who said that their care providers treated them with kindness and understanding‘all of the time’, ‘some of the time’ and ‘not at all’.All of the time Some of the time None of the timeSTATEWIDE PUBLIC83161Mackay Base Hospital (n=95)80182Mackay Birth Centre (n=14)100Proserpine Hospital (n=36)928STATEWIDE PRIVATE9010Mater Misericordiae Hospital Mackay (n=121)93610 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Goondiwindi Hospital 100%Longreach Hospital 100%Mareeba Hospital 100%Best public birth centres in Queensland:Mackay Birth Centre 100%Townsville Birth Centre 100%Best private hospital in Queensland:Mater Mothers’ Private Redland 99%What do women say about their care?“Staff are very helpful and supportive. While also sensitiveto individual needs and privacy”“My midwife…was a joy to have very understandingopen-minded and not at all judgmental. Although I didn'tknow her or meet her previously I felt I knew her. Shewas kind and very on to her job :) and made the wholefamily welcome”“Took way too long to get assistance and one particularmidwife told me my questions about how to wrap mybaby weren't important when other women weren't ableto breastfeed properly and had medical issues.”22

Indicator 9: Do care providers genuinely care about women’s wellbeing?Gold standard care is defined as women feeling that their care providers genuinely cared about their wellbeing all of the time.We asked women how frequently the following statement was reflective of their care: “When I saw care providers during mylabour and birth, they genuinely cared about my wellbeing.” Women could indicate ‘all of the time’, ‘some of the time’ or ‘not atall’.The graph displays the percentages of women who said that their care providers genuinely cared about their wellbeing ‘all of thetime’, ‘some of the time’ and ‘not at all’.All of the time Some of the time None of the timeSTATEWIDE PUBLIC84142Mackay Base Hospital (n=94)9091Mackay Birth Centre (n=14)100Proserpine Hospital (n=36)946STATEWIDE PRIVATE928Mater Misericordiae Hospital Mackay (n=120)95410 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Biloela Hospital 100%Goondiwindi Hospital 100%Mareeba Hospital 100%Stanthorpe Hospital 100%Best public birth centres in Queensland:Gold Coast Birth Centre 100%Mackay Birth Centre 100%Townsville Birth Centre 100%Best private hospital in Queensland:Mater Mothers’ Private Redland 99%What do women say about their care?“Everyone treated me with respect and I felt as thoughthey genuinely cared about my wellbeing. One nurse evencame to visit me the day after I had my daughter whenshe wasn't even on shift to say hello and see how I was.”“A lot of work needs to be done to provide a positive andsupportive environment for pregnant women. It isunfortunate that in many instances a woman's experienceis coloured by issues such as patient numbers/ indemnityinsurance/ hospital policy.”“Lovely staff - kind, caring, gentle & supportive. Promptresponses to needs for pain management.”23

Indicator 10: Do care providers respect women’s decisions?Gold standard care is defined as women feeling that their care providers respected their decisions all of the time.We asked women how frequently the following statement was reflective of their care: “When I saw care providers during mylabour and birth, they respected my decisions.” Women could indicate ‘all of the time’, ‘some of the time’ or ‘not at all’.The graph displays the percentages of women who said their care providers respected their decisions ‘all of the time’, ‘some ofthe time’ and ‘not at all’.All of the time Some of the time None of the timeSTATEWIDE PUBLIC80173Mackay Base Hospital (n=94)78193Mackay Birth Centre (n=14)100Proserpine Hospital (n=36)8614STATEWIDE PRIVATE89101Mater Misericordiae Hospital Mackay (n=121)92620 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Biloela Hospital 100%Mareeba Hospital 100%Best public birth centres in Queensland:Mackay Birth Centre 100%Townsville Birth Centre 100%Best private hospital in Queensland:Mater Mothers’ Private Redland 97%What do women say about their care?“The medical staff were great about presenting us withoptions and respecting our decision. I was made to feelwelcome, safe, respected and well cared for throughoutthe process.”“The emergency doctors didn't care so much for mydecisions. I really wanted a natural birth and I feel theydidn't exhaust all options before going to caesarean.”“I felt confident that the midwives would assist me withbirthing the way I had planned and that if there were anycomplications they would discuss them with me openly.”24

Part E: Support for Consumer PreferencesWomen have the right to have their preferences supported and accommodated. Depending on their background, values, cultureor religion, women may have different values and beliefs which may result in different preferences for their care during labour andbirth. It is important that care providers be attentive to women’s preferences and use effective communication to ensure thatthese needs are respected.We have reported on five indicators of support for women’s preferences.Indicator 11: Are women’s support people made to feel welcome during labour and birth?Having continuous support during labour has been shown to be associated with less frequent use of analgesia, shorter durationof labour, increased satisfaction with the birthing experience and less frequent use of instrumental or surgical delivery (Hodnett etal., 2007). Support people can assist women in a number of ways including the provision of emotional support, pain relief (e.g.massage, visualisation), and food and drink, and can also act as an advocate for women’s preferences for birth. Women’spreferences pertaining to the involvement of their support people should be responded to by care providers.Indicator 12: Are women’s support people made to feel welcome after birth?Whether their support people will be made to feel welcome is an important consideration for women when they are choosing abirth facility (Thompson & Wojcieszek, under review). The birth of a baby may be a major life event, not only for women, but alsofor their support people. It is important that care providers acknowledge this and ensure that support people are welcomed afterbirth, according to women’s preferences, to support bonding and attachment. Support people can also play a valuable role afterbirth in assisting women to care for both themselves and their babies.Indicator 13: Can women choose the gender of their care provider(s) for labour and birth?Some women, including women from particular cultural backgrounds, may prefer health care providers of the same gender(Queensland Government, 2007a). Based on the Australian Charter of Healthcare Rights, women in receipt of maternity careservices have a right to have their culture, beliefs, values and characteristics respected and acknowledged by care providers(ACSQHC, 2009). It is important to try to meet these needs as this may help to reduce fear and embarrassment, along withimproving women’s experience of care.Indicator 14: Do care providers allow women to take their time during labour?To demonstrate truly woman-centred care, women’s individual needs and preferences must be prioritised over the preferencesor agendas of institutions and care providers (ANMC, 2006). Genuine efforts must to be made to ensure that women receive highquality of care during labour and birth, regardless of how busy a facility may be at any given point. Interventions aimed ataugmenting the speed of labour should not be performed unless a woman makes a decision to accept such interventions afterbeing fully informed of the associated outcomes (NICE, 2007).Indicator 15: Do women feel that their medical procedures were necessary?Use of effective communication is essential for ensuring patient preferences are supported and accommodated. According tothe Australian Medical Council, part of communicating effectively with patients is providing adequate information about the natureof, and need for, any form of examination or intervention, along with the provision of sufficient time to ask questions or refusecare (AMC, 2009). Women have a right to make decisions about the treatment they receive (ACSQHC, 2009). As such,instances where women receive medical procedures that they feel are unnecessary highlight serious deficiencies in thecommunication between the care provider and the woman.25

Indicator 11: Are women’s support people made to feel welcome during labourand birth?Gold standard care is defined as women feeling that all of their support people are made to feel welcome during labour and birth.We asked women: “Were all of your support people (e.g. partner, husband, companion) made to feel welcome ... during yourlabour?...during your birth?”The graph displays the percentages of women who said that all of their support people were made to feel welcome both duringlabour and birth. 5STATEWIDE PUBLIC94Mackay Base Hospital (n=93)94Mackay Birth Centre (n=14)100Proserpine Hospital (n=35)100STATEWIDE PRIVATE98Mater Misericordiae Hospital Mackay (n=118)990 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Atherton Hospital 100%Biloela Hospital 100%Goondiwindi Hospital 100%Gympie Hospital 100%Innisfail Hospital* 100%Kingaroy Health Service 100%Proserpine Hospital 100%Stanthorpe Hospital 100%Best private hospitals in Queensland:Cairns Private Hospital 100%Mater Misericordiae Hospital Gladstone 100%Mater Mothers’ Private Redland 100%Nambour Selangor Private Hospital 100%St Vincent’s Hospital Toowoomba 100%Best public birth centres in Queensland:Gold Coast Birth Centre 100%Mackay Birth Centre 100%Royal Brisbane and Women’s Birth Centre 100%Townsville Birth Centre 100%What do women say about their care?“My support people were…made to feel welcome, and at notime were they asked to leave or made to feel like they werean intrusion.”“They made my husband wait outside maternity ward while Iwas having contractions. As they were busy, they would notmove me down to birthing, so my husband had to go homeand I was left alone.”“Midwives were great whilst giving birth, they got my husbandvery involved even though neither of us expected that.”5For women who did not have a labour, data for this indicator are based on whether their support people were made to feel welcome duringbirth.* Denotes a response rate of less than 25%26

Indicator 12: Are women’s support people made to feel welcome after birth?Gold standard care is defined as women feeling that all of their support people are made to feel welcome after birth.We asked women: “Were all of your support people (e.g. partner, husband, companion) made to feel welcome ... after yourbirth?”The graph displays the percentages of women who said that all of their support people were made to feel welcome after birth. 6STATEWIDE PUBLIC95Mackay Base Hospital (n=95)93Mackay Birth Centre (n=14)100Proserpine Hospital (n=35)100STATEWIDE PRIVATE98Mater Misericordiae Hospital Mackay (n=121)980 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Biloela Hospital 100%Dalby Hospital 100%Goondiwindi Hospital 100%Kingaroy Health Service 100%Mt Isa Hospital* 100%Proserpine Hospital 100%Stanthorpe Hospital 100%Best public birth centres in Queensland:Gold Coast Birth Centre 100%Mackay Birth Centre 100%Townsville Birth Centre 100%Best private hospitals in Queensland:Mater Misericordiae Hospital Gladstone 100%Mater Mothers’ Private Redland 100%Sunshine Coast Private Hospital 100%What do women say about their care?“Your partner and family are educated and involved in the birthingprocess, and you are able to stay as a family unit once the babyarrives which helps with bonding.”“Considering when I gave birth my husband should have been able tostay, especially as he was fatigued and it was a difficult and traumaticbirth…It was very dangerous for him to drive home and he wasforced to by the hospital.”“Excellent, having your husband stay with you at the hospital made itall the less stressful and helped create the right environment.”“I found it really disheartening that I wasn't allowed to have anyonestay with me the first night. I wasn't able to care for my baby as hewas in the special care nursery and I really would have appreciatedthe support as I felt quite down.”“My husband was able to stay at the hospital…after the birth. Thiswas a huge relief as he was invaluable in helping me to care for ourbaby after having had a c-section…having him there really cut downthe requirement of the nurses to care for me and my baby.”6Note, that this does not necessarily include being made to feel welcome overnight.* Denotes a response rate of less than 25%27

Indicator 13: Can women choose the gender of their care provider(s) for labourand birth?Gold standard care is defined as women being able to choose the gender of their care provider(s) for labour and birth.We asked women: “Could you choose whether your care provider(s) for labour/birth were male or female?”The graph displays the percentage of women who said that they could choose the gender or their care provider(s).STATEWIDE PUBLIC10Mackay Base Hospital (n=96)13Mackay Birth Centre (n=14)7Proserpine Hospital (n=36)3STATEWIDE PRIVATE27Mater Misericordiae Hospital Mackay (n=122)340 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Mareeba Hospital 29%Best public birth centre in Queensland:Townsville Birth Centre 29%Best private hospital in Queensland:Nambour Selangor Private Hospital 36%What do women say about their care?“My birth plan was not read or ignored as I was given amale midwife half way through my 22 hour labour. I did notfeel able to object at this painful time… a male studentmidwife was also allowed to walk straight up to me and askme whilst I was paused between painful and frequentcontractions if he could observe.”“I also was very uncomfortable with having males in theroom other than my partner. I made staff aware of this, andas I started pushing a male paediatrician came into theroom to observe me. I felt this unnecessary as I had nocomplication or drugs.”28

Indicator 14: Do care providers allow women to take their time during labour?Gold standard care is defined as women not feeling that they were rushed or hurried during labour.We asked women: “Did you feel rushed or hurried by your care provider(s) at any time during your labour?”The graph displays the percentage of women who said that they did not feel rushed or hurried by their care providers at any timeduring labour.STATEWIDE PUBLIC90Mackay Base Hospital (n=86)88Mackay Birth Centre (n=14)100Proserpine Hospital (n=32)78STATEWIDE PRIVATE91Mater Misericordiae Hospital Mackay (n=93)940 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Biloela Hospital 100%Dalby Hospital 100%Longreach Hospital 100%Stanthorpe Hospital 100%Warwick Hospital 100%Best public birth centres in Queensland:Mackay Birth Centre 100%Townsville Birth Centre 100%Best private hospital in Queensland:St Andrew’s Ipswich Private Hospital 98%What do women say about their care?“The staff are efficient without compromising onpatient care. It's obvious everybody is busy, but Inever felt rushed.”“My ob made me feel a little rushed and pressuredinto interventions”“Staff are professional and kind-even though it is abusy maternity ward, I never felt rushed.”“I was made to feel like I was a problem for thembecause I was taking too long to have my baby. I feltlike these midwives didn’t care about me at all.”29

Indicator 15: Do women feel that their medical procedures were necessary? 7Gold standard care is defined as women feeling that all of the medical procedures during their birth were necessary.We asked women: “Did you feel the medical procedures during your birth were necessary?”The graph displays the percentage of women who said that they had medical procedures during labour and birth and felt that‘all’ of the procedures were necessary.STATEWIDE PUBLIC80Mackay Base Hospital (n=67)81Mackay Birth Centre (n=4)Insufficient dataProserpine Hospital (n=30)77STATEWIDE PRIVATE89Mater Misericordiae Hospital Mackay (n=94)950 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Atherton Hospital 100%Biloela Hospital 100%Stanthorpe Hospital 100%Best public birth centre in Queensland:Royal Brisbane and Women’s Birth Centre 73%Best private hospital in Queensland:Mater Misericordiae Hospital Mackay 95%What do women say about their care?“I was treated quite badly during the birth. Choiceswere made that I felt unnecessary and now have to livewith.”“The centre is such a homely environment, themidwives are lovely and make you feel relaxed. Thereare no unnecessary examinations and tests.”“I had an emergency c-section but was not seen byan OB/GYN who was present for it in the daysfollowing while I was in hospital. It was…frustratingto not have been able to speak to someone whowas actually there to explain fully what happenedand why the c-section was necessary.”7Insufficient data for Gold Coast Birth Centre, Goondiwindi Hospital, Mackay Birth Centre, Mareeba Hospital and Townsville Birth Centre.30

Part F: Informed Decision-Making by ConsumersAn informed decision is one where the consumer is:• informed of the potential consequences (pros and cons) of accepting a treatment option and of not accepting thattreatment option, and• provided with the opportunity to make a decision about subsequent treatment.The Australian Charter of Healthcare Rights states that “(t)o obtain good health outcomes, it is important for patients andconsumers to participate in decisions and choices about their care and health needs” (ACSQHC, 2009). Health care providersshould “(e)ncourage patients and consumers to make fully informed decisions by discussing treatment options available,including expected outcomes, success rates and incidence of side effects. This includes informing patients and consumers oftheir right to refuse treatment or withdraw consent at any time” (ACSQHC, 2009).The majority of women (>96%) want to be involved in making decisions about their labour and birth (Brown & Lumley, 1998).Furthermore, women are significantly more likely to provide positive ratings of intrapartum care when they are involved in makingdecisions about their labour and birth care (Brown & Lumley, 1998). Better supporting women and families to make informeddecisions during pregnancy, labour, and birth was identified as a key priority in Re-birthing: The Review of Maternity Services inQueensland (Hirst, 2005).We have reported on five indicators of consumer informed decision-making.Indicator 16: Do women make informed decisions about caesarean section?There is evidence from South Australian women, that a considerable proportion feel uninvolved in the decision to have acaesarean section or feel that they were not given enough information about their available options (Turnbull et al., 1999). InQueensland, as in other regions, care providers must give women detailed information about the indications for a caesarean,including the risks and benefits of having or not having the procedure, before seeking their consent (Queensland Government,2011).Indicator 17: Do women make informed decisions about induction of labour?The Queensland Maternity and Neonatal Clinical Guideline on Induction of Labour (IOL) recommends that care providers“(d)iscuss the risks and benefits of IOL as they pertain to each individual woman to enable the woman to make an informeddecision in consultation with her health care provider” (QMNCGP, 2011).Indicator 18: Do women make informed decisions about vaginal examinations?Vaginal examinations during labour can be a source of considerable discomfort, embarrassment and distress for some women(Lai & Levy, 2002; Lewin et al., 2005). Research findings from the UK identify that many women would have liked moreinformation about intrapartum vaginal examinations and that they did not feel able to refuse the procedure (Lewin et al., 2005). Itis important that women are provided with sufficient, evidence-based information about vaginal examinations and offer theirconsent for the procedure to be carried out (NICE, 2007).Indicator 19: Do women make informed decisions about fetal monitoring?The Queensland Maternity and Neonatal Clinical Guideline on Intrapartum Fetal Surveillance states that “The advantages anddisadvantages of intrapartum fetal surveillance as they pertain to the individual woman should be discussed during pregnancy”and that a woman should make decisions about fetal monitoring in discussion with her care providers (QMNCGP, 2010).Indicator 20: Do women make informed decisions about epidural during labour?The Informed Consent for Invasive Procedures Policy, developed by Queensland Health, states women must make an informeddecision to have an epidural for pain relief for labour (Queensland Government, 2007b). As part of this process, women need tobe provided with unbiased information on the risks and benefits of the procedure before being asked to consent to the epidural.31

Indicator 16: Do women make informed decisions about caesarean section?Gold standard care is defined as women feeling that they made an informed decision to have a caesarean section (that is, thepros and cons were discussed and they decided from all their available options).We asked women who had a caesarean section: “Did your maternity care provider(s) discuss with you the pros and cons(benefits and risks) of having and not having a caesarean?” and “Who decided if you would or would not have a caesarean?”Indicator 16.1: Caesarean section scheduled in advance 8The graph displays the percentage of women who said they made an informed decision to have a caesarean section that wasscheduled in advance (i.e. a caesarean section that was decided on before women arrived at the hospital to have their baby).STATEWIDE PUBLIC51Mackay Base Hospital (n=8)Insufficient DataMackay Birth Centre (n=0)Insufficient DataProserpine Hospital (n=5)Insufficient DataSTATEWIDE PRIVATE53Mater Misericordiae Hospital Mackay (n=28)680 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Nambour Hospital 73%Best public birth centre in Queensland:Insufficient dataBest private hospital in Queensland:Sunshine Coast Private Hospital 71%What do women say about their care?“I would have liked there to be more information aboutmy choices with a breech baby…I did not like how itwas assumed that I would have a c-section…Eventhough it was the best option in the end I would haveliked the information presented to me and the decisionbe mine and guided by the health care professional.”“Procedures for general anaesthetic for caesarean(catheter inserted while conscious was not explainedto me), very painful and distressing.”8Insufficient data for Atherton Hospital, Biloela Hospital, Dalby Hospital, Emerald Hospital, Gladstone Hospital, Gold Coast Birth Centre,Goondiwindi Hospital, Gympie Hospital, Hervey Bay Hospital, Innisfail Hospital, Kingaroy Health Service, Longreach Hospital, Mackay BaseHospital, Mackay Birth Centre, Mareeba Hospital, Mater Misericordiae Hospital Gladstone, Mt Isa Hospital, Proserpine Hospital, Royal Brisbaneand Women’s Birth Centre, Stanthorpe Hospital, Townsville Birth Centre and Warwick Hospital.32

Indicator 16.2: Caesarean section not scheduled in advance 9The graph displays the percentage of women who said they made an informed decision to have a caesarean section that wasnot scheduled in advance (i.e. a caesarean section that was decided on after women arrived at the hospital to have their baby).STATEWIDE PUBLIC17Mackay Base Hospital (n=12)0Mackay Birth Centre (n=0)Insufficient dataProserpine Hospital (n=3)Insufficient dataSTATEWIDE PRIVATE24Mater Misericordiae Hospital Mackay (n=17)120 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Rockhampton Hospital 35%Best public birth centre in Queensland:Insufficient dataBest private hospital in Queensland:Mater Mothers’ Private Redland 31%What do women say about their care?“The staff were very friendly, open and honest from thebeginning. At no time was I made to feel stupid for thequestions I asked, and I was kept well informed at everystage. My every need was catered to with a smile, and Inever felt like I was inconveniencing anyone. All of myoptions were outlined clearly to me, and I was able to bea major part of every decision made.”“The OB decided that I would need a c-section andasked if this was ok. When my partner started to ask afew questions it became apparent that this was not ourdecision at all and we were treated like we should justbe quiet and do what we were told.”9Insufficient data for Atherton Hospital, Biloela Hospital, Dalby Hospital, Emerald Hospital, Gladstone Hospital, Gold Coast Birth Centre,Goondiwindi Hospital, Gympie Hospital, Hervey Bay Hospital, Innisfail Hospital, Kingaroy Health Service, Longreach Hospital, Mackay BirthCentre, Mareeba Hospital, Mater Misericordiae Hospital Gladstone, Mt Isa Hospital, Proserpine Hospital, Royal Brisbane and Women’s BirthCentre, St Andrew’s Ipswich Private Hospital, Stanthorpe Hospital, Townsville Birth Centre and Warwick Hospital.33

Indicator 17: Do women make informed decisions about induction of labour? 10Gold standard care is defined as women feeling that they made an informed decision to have an induction of labour (that is, thepros and cons were discussed and they decided from all their available options).We asked women who had an induction of labour: “Did your maternity care provider(s) discuss with you the pros and cons(benefits and risks) of being induced and not being induced?” and “Who made the decision to induce or not induce you?”The graph displays the percentage of women who said they made an informed decision to have an induction of labour.STATEWIDE PUBLIC19Mackay Base Hospital (n=9)Insufficient dataMackay Birth Centre (n=0)Insufficient dataProserpine Hospital (n=2)Insufficient dataSTATEWIDE PRIVATE36Mater Misericordiae Hospital Mackay (n=27)520 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Caboolture Hospital 39%Best public birth centre in Queensland:Insufficient dataBest private hospital in Queensland:Mater Misericordiae Hospital Mackay 52%Nambour Selangor Private Hospital 52%What do women say about their care?“Staff are amazing everyone genuinely wantsto help you. Every decision is yours to makewithout any pressure but with all the facts.”“I felt pressured by my OBGYN to be inducedand was not aware that being induced meantI would be stuck in a bed and hooked up to adrip”10Insufficient data for Atherton Hospital, Biloela Hospital, Cairns Private Hospital, Dalby Hospital, Emerald Hospital, Gladstone Hospital, GoldCoast Birth Centre, Goondiwindi Hospital, Gympie Hospital, Hervey Bay Hospital, Innisfail Hospital, John Flynn Private Hospital, Kingaroy HealthService, Longreach Hospital, Mackay Base Hospital, Mackay Birth Centre, Mareeba Hospital, Mater Misericordiae Hospital Gladstone, Mt IsaHospital, Proserpine Hospital, Royal Brisbane and Women’s Birth Centre, St Andrew’s Ipswich Private Hospital, Stanthorpe Hospital, TownsvilleBirth Centre and Warwick Hospital.34

Indicator 18: Do women make informed decisions about vaginal examinations? 11Gold standard care is defined as women feeling that they made an informed decision to have vaginal examinations (that is, thepros and cons were discussed and they decided from all their available options).We asked women who had at least one vaginal examination: “Did your maternity care provider(s) discuss with you the pros andcons (benefits and risks) of having and not having vaginal examinations?” and “Who made the decision to have or not havevaginal examinations?”The graph displays the percentage of women who said they made an informed decision to have vaginal examinations duringlabour.STATEWIDE PUBLIC13Mackay Base Hospital (n=37)19Mackay Birth Centre (n=1)Insufficient dataProserpine Hospital (n=16)0STATEWIDE PRIVATE10Mater Misericordiae Hospital Mackay (n=42)50 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Caboolture Hospital 25%Best public birth centre in Queensland:Royal Brisbane and Women’s Birth Centre 40%Best private hospital in Queensland:John Flynn Private Hospital 21%What do women say about their care?“After I gave birth…the midwife completely violated mypersonal space prodding the entrance to my vaginawith her finger apparently to see whether I had torn ornot, causing me extreme pain since I just gave birthout of there, also minor grazing. She told me what shewas doing just as she touched me so I couldn't sayno.”“Women should be more informed of their choices bymedical care providers. Once women make an informeddecision this should be respected and encouraged.”11Insufficient data for Atherton Hospital, Biloela Hospital, Emerald Hospital, Gold Coast Birth Centre, Goondiwindi Hospital, Gympie Hospital,Innisfail Hospital, Longreach Hospital, Mackay Birth Centre, Mareeba Hospital, Stanthorpe Hospital, Townsville Birth Centre and WarwickHospital.35

Indicator 19: Do women make informed decisions about fetal monitoring? 12Gold standard care is defined as women feeling that they made an informed decision about how their baby would be monitoredduring labour (that is, the pros and cons were discussed and they decided from all their available options).We asked women who had fetal monitoring during labour: “Did your maternity care provider(s) discuss with you the pros andcons (benefits and risks) of monitoring and not monitoring your baby?” and “Who made the decision if/how your baby wasmonitored?”The graph displays the percentage of women who said they made an informed decision to have fetal monitoring during labour.STATEWIDE PUBLIC9Mackay Base Hospital (n=40)13Mackay Birth Centre (n=7)Insufficient dataProserpine Hospital (n=19)5STATEWIDE PRIVATE8Mater Misericordiae Hospital Mackay (n=43)50 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Caboolture Hospital 18%Best public birth centre in Queensland:Royal Brisbane and Women’s Birth Centre 32%Best private hospital in Queensland:Nambour Selangor Private Hospital 17%What do women say about their care?“I was extremely well supported and fully informed. Mydecisions were always respected even when they were inconflict with hospital policies (i.e. continual monitoring wasrejected in early labour).”“Was very disappointed with the lack of information duringlabour…On arrival I was given a room put onto a bed andstrapped up to monitors around my belly and was left likethis for my whole time in labour at hospital. I was never toldwhy I was strapped up as there were no complications andI didn't even know why I wasn't allowed to move as thismade my labour my painful having to stay on the bed.”12Insufficient data for Atherton Hospital, Biloela Hospital, Dalby Hospital, Gold Coast Birth Centre, Goondiwindi Hospital, Innisfail Hospital,Mackay Birth Centre, Mareeba Hospital, Stanthorpe Hospital, Townsville Birth Centre and Warwick Hospital.36

Indicator 20: Do women make informed decisions about epidural duringlabour? 13Gold standard care is defined as women feeling that they made an informed decision about having an epidural (that is, the prosand cons were discussed and they decided from all their available options).Of those who had a labour, we asked women who had an epidural: “Did your maternity care provider(s) discuss with you thepros and cons (benefits and risks) of having and not having an epidural (an injection in your back for pain relief) during yourlabour?” and “Who decided if you would or would not have an epidural during your labour?”The graph displays the proportion of women who had a labour and made an informed decision to have an epidural.STATEWIDE PUBLIC65Mackay Base Hospital (n=13)69Mackay Birth Centre (n=0)Insufficient dataProserpine Hospital (n=5)Insufficient dataSTATEWIDE PRIVATE73Mater Misericordiae Hospital Mackay (n=19)630 10 20 30 40 50 60 70 80 90 100Best public hospital in Queensland:Toowoomba Hospital 77%Best public birth centre in Queensland:Insufficient dataBest private hospital in Queensland:Mater Mothers’ Private Redland 100%What do women say about their care?“I cannot speak highly enough about the care I received ina midwife base care model where trust was developedbetween me and my care providers. I was fully informedabout my options at all times and all of my decisions wererespected. There is a lot to be said about this model ofcare and it should be more readily available.”“I had decided in my birth plan I wanted an epidural. I wasgiven one however when the midwives changed shifts thenew midwife told me I was no longer allowed to use it.”13Insufficient data for Atherton Hospital, Biloela Hospital, Dalby Hospital, Emerald Hospital, Gladstone Hospital, Gold Coast Birth Centre,Goondiwindi Hospital, Gympie Hospital, Hervey Bay Hospital, Innisfail Hospital, John Flynn Private Hospital, Kingaroy Health Service, LongreachHospital, Mackay Birth Centre, Mareeba Hospital, Mater Misericordiae Hospital Rockhampton, Mater Misericordiae Hospital Gladstone, Mt IsaHospital, Proserpine Hospital, Stanthorpe Hospital, St Andrew’s Ipswich Private Hospital, Townsville Birth Centre and Warwick Hospital.37

Part G: Quality of Labour and Birth RoomsGood quality labour and birth rooms ensure that women’s privacy and dignity are protected and provide a clean, hygienic andcomfortable environment for birth.We have reported on two indicators of the quality of the labour and birth rooms.Indicator 21: Was the cleanliness of the labour and birth rooms adequate?Women have a right to receive care in an environment that adheres to high standards of cleanliness and hygiene, to assist inproviding the best outcomes in terms of their health, safety and personal comfort.Indicator 22: Was the privacy of the labour and birth rooms adequate?The right to privacy and confidentiality is one of the core components of the Australian Charter of Healthcare Rights (ACSQHC;2009). Women have a right to confidentiality in relation to their medical records and health conditions. Therefore, care providershave a responsibility to maintain this confidentiality at all times. During labour, birth and after birth, care providers also have aresponsibility to respect women’s privacy within the environment where care is provided. This includes asking for permissionbefore entering a woman’s room or touching her, providing women with appropriate shielding during examinations orprocedures, and providing detailed explanations of potentially invasive procedures prior to women providing consent.38

Indicator 21: Was the cleanliness of the labour and birth rooms adequate?Gold standard care is defined as women feeling that the cleanliness of the labour and birth rooms does not need improvement.We asked: “Were there any aspects of the room for labour and birth that needed improvement?” Women were asked to selectthe aspects of the labour and birth rooms they felt needed improvement from a list including ‘cleanliness’. Women could alsoindicate that nothing needed improvement.The graph displays the percentage of women who did not say that the cleanliness of the labour and birth rooms neededimprovement.STATEWIDE PUBLIC97Mackay Base Hospital (n=82)95Mackay Birth Centre (n=12)100Proserpine Hospital (n=32)100STATEWIDE PRIVATE99Mater Misericordiae Hospital Mackay (n=101)990 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Biloela Hospital 100%Caboolture Hospital 100%Dalby Hospital 100%Emerald Hospital 100%Gladstone Hospital* 100%Goondiwindi Hospital 100%Innisfail Hospital* 100%Mareeba Hospital 100%Proserpine Hospital 100%Best private hospitals in Queensland:Cairns Private Hospital 100%Mater Misericordiae Hospital Gladstone 100%Mater Misericordiae Hospital Rockhampton 100%Mater Mothers’ Private Hospital 100%Mater Mothers’ Private Redland 100%Nambour Selangor Private Hospital 100%St Andrew’s Ipswich Private Hospital 100%St Vincent’s Hospital Toowoomba 100%Best public birth centres in Queensland:Mackay Birth Centre 100%Royal Brisbane and Women’s Birth Centre 100%Townsville Birth Centre 100%What do women say about their care?“The birthing suite was very spacious, modernand very clean.”“It would have been nice to have my bed sheetschanged at least once during my hospital stay.”“Private and clean rooms, midwives and nursessupportive, rooms had relaxing view.”* Denotes a response rate of less than 25%39

Indicator 22: Was the privacy of the labour and birth rooms adequate?Gold standard care is defined as women feeling that the privacy of the labour and birth rooms does not need improvement.We asked: “Were there any aspects of the room for labour and birth that needed improvement?” Women were asked to selectthe aspects of the labour and birth rooms they felt needed improvement from a list including ‘privacy’. Women could alsoindicate that nothing needed improvement.The graph displays the percentage of women who did not say that the privacy of the labour and birth rooms neededimprovement.STATEWIDE PUBLIC92Mackay Base Hospital (n=82)89Mackay Birth Centre (n=12)100Proserpine Hospital (n=32)94STATEWIDE PRIVATE97Mater Misericordiae Hospital Mackay (n=101)950 10 20 30 40 50 60 70 80 90 100Best public hospitals in Queensland:Biloela Hospital 100%Dalby Hospital 100%Emerald Hospital 100%Goondiwindi Hospital 100%Gympie Hospital 100%Mareeba Hospital 100%Stanthorpe Hospital 100%Best public birth centres in Queensland:Gold Coast Birth Centre 100%Mackay Birth Centre 100%Townsville Birth Centre 100%Best private hospitals in Queensland:Mater Misericordiae Hospital Gladstone 100%Mater Mothers’ Private Redland 100%What do women say about their care?“Wonderful staff that were welcoming and put usat ease. They gave us privacy when we wanted itand assisted when asked to.”“The reason I left hospital after less than 3 days:No privacy (midwives/doctors never knocked, leftdoor open while I was changing).”“All of the staff were extremely helpful andsupportive and friendly but at the same time werevery respectful of your privacy and space.”“The two way toilet door’s lock was broken whichmade for some very uncomfortable intrusions bymyself and the other mum sharing the toilet.”40

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