A healthy partnership between medical and midwifery teams

In an interview published in The Sunday Times of Malta on January 16, 2011, I, in my role as secretary of the Malta College of Obstetricians & Gynaecologists, said that Maltese obstetricians will not apologise for the perceived high rate of medical interventions in childbirth.

This interview was given in the wake of a threat of industrial action by the Malta Union of Midwives and Nurses following their claim that we, the obstetricians at Mater Dei Hospital were being too interventionist in our practice.

It was the time when, in the UK, midwifery-led practices were pursuing a completely natural approach to childbirth. The result was that, in 2015, an NHS trust where ‘a natural birth at all costs policy’ was followed cost the lives of 11 babies.

Following this and other reports, in 2017 the Royal College of Midwives abandoned its campaign for natural births.

Most recently, following the Panorama programme in February of this year, NHS England wrote to all England’s Hospital Trusts to abandon caesarean section rates as a performance measure.

It is a relief that the college found the support of successive ministers to keep hospital-based obstetrics as we have known it since moving to Mater Dei Hospital. This prevented similar tragic occurrences happening here.

However, while we steadied the ship during trying circumstances, we must now be open to new realities. There is real pressure in our hospital to provide care to a very high standard, given the increase in the birthing population with our expat population rising.

And, as society develops, the demands increase accordingly. It is now no longer possible to hold a proper obstetric consultation within the few minutes allocated in a busy clinic.

Prenatal diagnosis is improving and, therefore, time for discussion is not a luxury which staff and patients have to fight to carve out of their busy schedule. This is a time when joint decision making is encouraged and informed consent a must.

Another phenomenon which has appeared is the rise in private obstetrics. This must be attributed to the restrictions imposed by the unfortunate COVID-19 pandemic making some couples feel that a private birth was the better option. And there are quite a few skilled fully trained obstetricians who practise only privately to allow this.

These patients have also appreciated the time afforded them by their carers in an environment where rush is not the order of the day.

So, with medical staffing levels stuck at well below par of the EU average (2.5 per 1,000 in Malta compared to five in the UK and 6.6 in Australia) this problem is only getting worse.

With the obsession of natural childbirth at all costs mentality finally addressed, I think the time may be opportune to engage with the midwifery community and start serious discussions, leaving power and control out of these talks.

Midwives are fully trained university graduates who can contribute significantly to the care of our pregnant women. They certainly have the training to explain and reassure women and the health service must tap into this to improve our counselling. After all, we all know that problems often arise out of misunderstandings or poor communication.

A healthy partnership of co-operation between the medical and midwifery teams needs to be developed at policy level such that the standard of care of expectant mothers can take that quantum leap it so desperately needs.

MARK FORMOSA – Sliema

‘Wealthy foreigners’

Once again, John Vassallo (‘How to deal with Russia’, March 27) tendentiously denounces “wealthy foreigners” who “pay only 15 per cent on what they transfer to Malta”.

As a UK citizen lawfully resident in Malta, and paying tax here, I feel that, in fairness, he should also mention that Maltese and other “foreigners” lawfully resident in the UK also benefit from tax breaks.

They include generous tax relief on private pension contributions, tax-free growth on private pension investments and up to £20,000 tax-free investment and completely tax-free growth per year in an Individual Savings Account (ISA). In addition, 25 per cent of private pension funds are completely free of income tax. As we say in the UK, “fair exchange is no robbery”.

ALAN COOKE – Sliema

Why look for scapegoats?

Now that the results of the general election are out and the figures are able to give us a holistic picture of how the electorate voted, shouldn’t we reflect and try to fathom why people have voted in a particular manner or not voted at all?

What disappoints me most is the fact that, rather than giving ourselves enough time to reflect and reach factual conclusions, some of us look for scapegoats. We seem to want answers here and now.

Obviously, various factors and considerations should be taken into account as people cast their vote for different reasons. But why does one, for example, put the blame squarely on PN leader Bernard Grech when, as pointed out, the reason why one votes or abstains is so personal.

It is by finding out why individuals from both main parties have refrained from voting – and this is a substantial number, the highest percentage in decades – and why certain categories of people voted for their respective parties or opted for third parties that one can come to valid conclusions.

And what about the number of invalid votes that amounted to 8,802?

Some commentators, when talking about the dismal performance of the Nationalist Party, have remarked that, by focusing more on the bigger picture, the micro aspect could have been given less importance. Again, this could have been one reason. But let us not now abandon our lofty ideals that help us live as a community and focus more on the ‘I’ rather than on the ‘we’.

We need to reflect on what politics means for our society and what the majority of us citizens expect from politicians. Are many of us ignoring ideals like the common good, good governance anti-corruptive practices and safeguarding the environment by focusing more on the here and now? Is it ‘money talks’ and ‘money makes the world go round’ that is overriding all other priorities? How people vote reflects what people value most.

We need, yes, to reflect and listen to the various voices of our electorate but we also need to keep insisting that those ideals that a democratic country should abide by still remain the hallmark of our society.

Let us analyse and reflect on the results but let us not do away with those ideals and universal values on which policies and manifestos should be based simply to be populist and give what the people want rather than what is needed for a healthy and inclusive society.

RAY AZZOPARDI – Xemxija