Women's health

There is a need to protect against risks considered unacceptable in Australian practice

Martyn A Stafford-Bell MB BS, FRCOG, FRANZCOG · Sam G Everingham BSc, MA, MPH · Karin Hammarberg RN, BSc, PhD

Through gynaecological cancer prevention and treatment, assisted reproduction and good pregnancy care

Tania Janusic

Assisted reproductive technology has come a long way in 40 years

Gabor T Kovacs MD, FRANZCOG, CREI

Vaccinated women need to be screened

Annabelle Farnsworth MB BS(Hons), FRCPA, FIAC

This much maligned galactagogue may carry no direct risk to breastfeeding women

Luke E Grzeskowiak PhD, BPharm(Hons), GradCertClinEpid · Lisa H Amir MB BS, MMed, PhD

Concerns that women may not continue to participate in screening appear to be warranted

Alison C Budd PhD · Julia M L Brotherton BMed(Hons), MPH(Hons), FAFPHM · Dorota M Gertig MB BS(Hons), ScD, FAFPHM · Theresa Chau BPsychSc · Kelly T Drennan BHlthSc, PGCertCommDev · Marion Saville MB ChB, FIAC, GradDipMed(ClinEpi)

Reasons behind geographic and socioeconomic differences in survival warrant further investigation

Satyamurthy Anuradha MB BS, FRCS, PhD · Penelope M Webb MA, DPhil · Penny Blomfield MB BS, FRANZCOG, CGO · Alison H Brand MD, FRANZCOG, CGO · Michael Friedlander FRACP · Yee Leung MB BS, FRANZCOG, CGO · Andreas Obermair MD, FRANZCOG, CGO · Martin K Oehler MD, FRANZCOG, CGO · Michael Quinn MB ChB, FRANZCOG, CGO · Christopher Steer MB BS, FRACP · Susan J Jordan MB BS, FRACGP, PhD

A high standard of pregnancy care should be provided for all women

Caroline M de Costa PhD, MPH, FRANZCOG

Up to 50% of women diagnosed under the new criteria do not meet the agreed risk threshold

Michael C d’Emden MB BS, PhD, FRACP

Objectives: To investigate the characteristics of parents and intended parents and their current and planned behaviour in relation to surrogacy arrangements. Design, setting and participants: Members of two Australian parenting support forums who were considering surrogacy or were currently or previously in a surrogacy arrangement were invited to complete an online survey during July 2013. Main outcome measures: Sociodemographic characteristics; proportions engaging in domestic uncompensated and overseas compensated arrangements; countries used; costs incurred; and impact on behaviour of state laws criminalising compensated surrogacy. Results: Of 1135 potential participants, 312 (27%) commenced the survey. Of these, 24 did not fulfil inclusion criteria and 29 did not complete the survey. Eighty-nine respondents were considering surrogacy and 170 had commenced or completed surrogacy. Many respondents (53%) considered both overseas and domestic surrogacy. Among those who only considered one option, overseas surrogacy was considered significantly more often than domestic surrogacy (92% v 8%; P < 0.05). Only 22 respondents (8%) commenced with a surrogate in Australia. The most common countries used for compensated surrogacy were India and the United States, and average total estimated costs were $69 212 for India and $172 347 for the US. Barriers discouraging domestic surrogacy included concern that the surrogate might keep the child (75%), belief that it was too long and complicated a process (68%) and having no one of the right age or life stage to ask (61%). Few intended parents (9%) were deterred by state laws criminalising compensated surrogacy. Conclusions: Most Australian intended parents via surrogacy consider or use overseas compensated arrangements. Laws banning compensated surrogacy do not appear to deter those seeking surrogacy arrangements.

Sam G Everingham BSc, MA, MPH · Martyn A Stafford-Bell MB BS, FRCOG, FRANZCOG · Karin Hammarberg RN, BSc, PhD

MSF reflects on the emergency medical response in the wake of a disaster

Daniel Martinez Garcia MD · Alexandra L Brown BA

There is still no consensus about the VTE risk with newer contraceptive pills

Therese M Foran MB BS, MClinEd, FAChSHM

More attention to treating women is needed to prevent FASD

Lucy Burns · Courtney Breen · Adrian J Dunlop

Fewer women receive information and counselling about emergency contraception from their GP

Danielle Mazza MD, FRACGP · Christopher M Harrison BPsych(Hons), MSocHlth · Angela J Taft BA, MPH, PhD · Helena C Britt BA, PhD · Melissa Hobbs RN, MPH, PhD · Kay Stewart BPharm(Hons), PhD · Safeera Hussainy BPharm(Hons), PhD, GCHE · Bianca R Brijnath BA(Hons), PhD

The potential for unwarranted terminations being contemplated is concerning

Ronald P Batagol

Complex matters of health care demand considered, holistic and compassionate responses

Diana McKay

Better facility-based outcomes for mothers and newborns are within reach

Myrto M Schaefer MD, MSc · Alexandra L Brown BA

Non-invasive prenatal testing heralds a new era in antenatal care

Stefan C Kane MB BS, BMedSc, FRANZCOG · Fabricio Da Silva Costa PhD, FRANZCOG, COGU · Shaun P Brennecke MB BS, DPhil, FRANZCOG

To the Editor: Lee and colleagues assessed the hospital caesarean section (CS) rates among hospitals in New South Wales according to the Robson 10-group classification. They identified the 20th centile CS rate for each group.1 These data could be used in Australian maternity services to reduce CS rates and potentially increase the quality of care. Monitoring the quality of care in maternity services has been difficult ...

Rick J Fielke

In reply: We thank Fielke for his interest in our article.1 Our study used the 20th centile method of the Australasian clinical indicator report on obstetrics, conducted by the Australian Council on Healthcare Standards (ACHS).2 The ACHS defines the 20th centile as a “best practice rate” that is potentially achievable and uses it to identify and prioritise clinical areas in which research and quality improvement ...

Yuen Yi (Cathy) Lee · Christine L Roberts · Jillian A Patterson

Investment in women is central to future global development

Catherine R Bateman-Steel MB ChB, BSc, MSc

The safety and benefits of homebirth remain contentious

Susan Ieraci · Amy B Tuteur

To the Editor: The recent article by Catling-Paull and colleagues1 documents the apparently very low perinatal mortality associated with state-funded homebirth, mostly among women in Western Australia. However, the 2007 triennial report of the WA Government Perinatal and Infant Mortality Committee (PIMC) stated that, for homebirth: The term perinatal mortality rate was 6.7 per 1000 total births, compared with a term perinatal mortality rate of 2.1 per 1000 total births in the ...

Donald M Clark

In reply: We agree that our retrospective review1 did not provide all the details about neonatal morbidity and mortality. There were limited data available on the reasons for hospital transfer and neonatal death. We explained these limitations in the article and have hence embarked on a wider study of birthplace in Australia.2 It was interesting to us that even in this low-risk population, there were 10 breech ...

Christine Catling-Paull · Rebecca L Coddington · Maralyn J Foureur · Caroline S E Homer

To the Editor: Despite evidence supporting the safety and benefits of influenza vaccination during pregnancy,1,2 half of pregnant women believe the influenza vaccine to be unsafe or are uncertain about its safety in pregnancy.3 Other studies report confusion among antenatal care providers about the safety of influenza vaccination during pregnancy, and cite the need for more professional education.4 To help address these safety concerns, the Western ...

Annette K Regan · Christopher C Blyth · Paul V Effler