In view of the shortage of obstetricians, a stratified, but complementary maternal care system with midwives playing a crucial role could solve the predicament, said Chou Ming-ming (周明明), director of obstetrics and gynecology at Taichung Veterans’ General Hospital.
“Who will deliver Taiwanese babies?” Chou asked during a presentation at the celebration of the establishment of the Taiwan Maternal Fetal Medicine Society on Sunday, saying that the number of practicing obstetricians and gynecologists had grown at an average of 16 percent over the past 10 years, compared with 30 percent for surgery, 45 percent for internal medicine and 54 percent for pediatrics.
“The average age of practicing gynecologists and obstetricians is 54.7, higher than those in other areas of medicine,” Chou said, adding that as new workforce merely trickles in and the “old soldiers gradually fade away,” a manpower shortage is imminent.
Other causes of the manpower attrition are the increase in disputes and malpractice litigation, how the National Health Insurance (NHI) pays gynecologists and obstetricians, how it pays obstetricians handling high-risk cases, unpredictable working hours and high emotional stakes, Chou said.
Chou applauded a plan by the government to aid, after a consensus between the patient and the hospital has been reached, those suffering from delivery mishaps, and recommended institutionalizing the resolution and mediation of such disputes.
Adjusting NHI payments to obstetricians and maternal-fetal medicine specialists and providing greater economic incentives to recruit doctors into the field requires further action, Chou said.
Chou also said Taiwan should follow the UK’s lead on midwifery, saying that certified midwives can mitigate the overwork that obstetricians face.
“Their presence is a plus to the pregnant woman, her family and obstetricians, who should work in partnership with midwives, rather than regarding them as competitors,” Chou said.
“There is a clear division of labor between midwives and obstetricians in the UK, with obstetricians in charge of only those experiencing high-risk pregnancies. Midwives deliver between 40 and 68 percent of babies born in the UK every year,” Chou said.
There are more than 50,000 certified midwives in Taiwan, but less than 130 are practicing, according to Chou’s data.
There is still a lot more work to be done for a better mother-friendly childbirth system, Chou said.