Dandenong Hospital could soon become one of Melbourne’s only major public hospitals unable to regularly care for sick or premature newborn babies under a controversial plan to redirect women with riskier pregnancies to other health services.
The Monash Health proposal has caused an uproar among some local midwives, Victoria’s nursing union and the state opposition given Dandenong Hospital is known for treating walk-in patients who have no prior contact with the hospital, and who speak little to no English.
Dandenong Hospital management want to redirect higher-risk pregnancies and newborns who require specialist care to sister sites. Credit: Eddie Jim
Women from this cohort, who are often refugees, sometimes give birth at Dandenong, in Melbourne’s outer south-east, less than an hour after presenting at the hospital’s emergency department.
The Australian Nursing and Midwifery Federation (ANMF) is also concerned that redirecting expectant mothers to hospitals 20 minutes’ drive away could extend patient travel times, complicate cases where babies are born on the way to Dandenong Hospital and place unnecessary strain on workers at other health services.
The ANMF believes the changes could lead to up to 600 women needing to be redirected to alternative birthing services each year, and has questioned whether Casey Hospital and Monash Medical Centre can absorb these patients and their babies.
But Monash’s modelling suggests this figure will be closer to 250 women per year – the equivalent of 10 per cent of Dandenong Hospital births. Hospital data shows that births are on the rise at Casey, but have remained steady at Dandenong.
Monash Health, which runs Dandenong Hospital, insists its proposal would be the best use of its resources and is underpinned by patient data.
“This is about saving lives and enhancing patient outcomes – not reducing care,” a Monash Health spokesperson said.
“There will be no job losses as a result of these changes. We are consulting with staff, unions, and the Victorian government, and will communicate further details on timelines once consultation concludes.”
Dandenong Hospital obstetricians and midwives have been told, in documentation and staff meetings, that Monash Health plans to reduce the capacity and capability of the hospital’s special care nursery in coming months.
The current plan suggests women with medium-risk pregnancies will no longer birth at Dandenong Hospital. These women and newborns needing specialist care will instead be transferred to Monash Medical Centre in Clayton, Casey Hospital in Berwick, or another health service.
Due to ongoing consultations, it is not yet known exactly how many midwifery roles will be relocated from Dandenong to Clayton, but staff at Monash Medical Centre have been told many new positions will be created there.
Dandenong Hospital has previously catered for premature and unwell babies born at 34 weeks. Under the current proposal, Dandenong would continue to care for low-risk women and newborns.
In Australia, a moderate-risk pregnancy is generally categorised as a mother having a history of health complications or developing one during pregnancy such as diabetes, high blood pressure or heart disease. These women generally require more frequent check-ups, a personalised care plan and their babies may need additional care when born.
A baby born at 34 weeks is considered to be a late preterm infant. These babies may require a short stay in a special care nursery to assist with things like maintaining their body temperature.
One midwifery source with links to Dandenong Hospital, who spoke on the condition of anonymity because she was not authorised to speak publicly, said she had regularly cared for refugees with complex needs and little to no English. Some were survivors of female genital mutilation, they said, and some walked through the hospital doors for the first time without any family members – only to deliver their baby less than an hour later.
“Could you get a more vulnerable group of women? Probably not,” the midwifery source said.
“These women deserve gold standard, midwifery-led continuity of care in a local community, culturally attuned to their needs.”
A second midwifery source described the changes as cuts.
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The union also says that, as of last week, Monash Health has not consulted with Victoria’s Paediatric Infant Perinatal Emergency Retrieval (PIPER) service, which transports women and neonates across the state as required.
ANMF state secretary Maddy Harradence, who took over from long-serving secretary Lisa Fitzpatrick last month, said her members had been fighting for years to prevent the relocation of medium-risk birthing and neonatal services to Casey Hospital.
“Women who were planning to have their baby at Dandenong Hospital will be distressed at the thought of having to relocate further away from home for their birthing needs or to visit their unwell baby who could have been cared for close to home at Dandenong Hospital,” Harradence said.
The Monash Health spokesperson said Dandenong would continue to provide excellent maternity and newborn services for the local community.
“Under our proposal, higher risk pregnancies and newborns who require specialist care will be managed at Casey Hospital or Monash Medical Centre and Monash Children’s Hospital, where the necessary expertise and resources are concentrated to ensure the safest possible outcomes for mothers and babies.”
Monash Health is not the first health service looking to consolidate its services. Earlier this year, this masthead revealed management at Eastern Health wanted Maroondah Hospital to drop speciality paediatric services in favour of an expanded paediatrics hub at sister hospital Box Hill.
The government stepped in to block the proposal after the reporting.
A spokesperson for Health Minister Mary-Anne Thomas said the proposals had been supported by Safer Care Victoria.
“[They] involve full consultation, no budget cuts or impact on frontline staff.”
While the May budget handed a record $31 billion spending to Victoria’s health system, hospitals are also being asked by the health department to find efficiencies where they can.
Opposition health spokeswoman Georgie Crozier said the proposed changes to Dandenong Hospital’s special care nursery would lead to worse outcomes for some of Victoria’s most vulnerable women.
“Labor can’t manage money, can’t manage health and it’s Victorians who are paying the price.”
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