Vaginal examinations are being performed on mothers without consent at Canberra Hospital, amid a toxic hierarchy and political environment, a midwife says.
It's the latest in a long line of concerns outlined by mothers and staff at Centenary Hospital for Women and Children - part of the Canberra Hospital campus - since a scathing letter was sent to the Health Minister from hospital staff last year.
Allegations of inductions being dangerously delayed, mothers being sent home due to lack of beds and a serious lack of midwives working in the birthing suite have been made in submissions to an ongoing inquiry into ACT's maternity services.
A Centenary midwife said she had witnessed many women being coerced into procedures without proper consent, including vaginal examinations.
"Recent consumer feedback [highlighted] a woman receiving a vaginal examination without her consent," the midwife said in a submission.
"Regardless of the circumstances of this intervention, a woman’s consent is paramount to any procedure whilst she is in our care.
"Hospital policy clearly states offering a woman a vaginal examination every 4-6 hours in active labour, yet staff - midwives and doctors alike - [are] performing examinations on women on arrival to gain a 'baseline'.
"Currently the Cochrane Review finds no convincing evidence that performing such examinations correctly determines a woman’s progress."
The midwife said there was a toxic hierarchy and political environment in the birthing space between obstetrics and midwifery that made collaboration with women's care exasperating.
She claimed some obstetric staff consistently tried to micromanage normal, low-risk women.
She said some doctors would not knock on doors before entering a room and spoke to women using fearful and unconstructive language without collaboration with the midwife.
"I’ve witnessed unnecessary intervention take place because of this, and a midwife’s inability to advocate for a woman due to this damagingly, tiered system," she said.
"An incident [included] where a doctor entered the wrong room, and proceeded to conduct an intervention, without realising it was the wrong room/woman until it was too late."
The midwife reiterated concerns shifts at Canberra Hospital's maternity wards were dangerously short of midwives.
"This not only affects the women who have either scheduled inductions booked, but also puts extra pressure on an already depleted staff pool," she said.
"This consequently causes a cascade effect, where labouring women are forced to progress quickly so that they can birth, and be out the door as soon as possible, so another woman can begin."
The inquiry has received 40 submissions but public hearings are not due to be held until later in the year.
The submissions have come from mothers, unions, staff and consumer groups with common themes of understaffing, poor morale, delayed inductions and lack of beds at Centenary Hospital.
Another midwife said staff were often inundated with texts messages on a daily basis asking them to work extra shifts.
Mothers said they were told to go home when arriving at the hospital, despite believing their pregnancies were quite far along.
"From my waters breaking to giving birth, the whole thing took 90 minutes. If we’d gone home when the midwife suggested, I would have given birth in the lift," one submission read.
"After the birth, we were left in the room, unattended, for hours. My husband slept on the floor.
"I was covered in muck and that black baby poo – we hadn’t been given a nappy."
A number of submissions highlighted how a lack of staff or lack of beds had delayed or cancelled inductions.
A Canberra Health Services spokeswoman said the hospital took patient consent very seriously, and staff were required to adhere to clear policies, procedures and expectations around gaining consent prior to any invasive procedure.
She said a new nursing and midwifery strategy was actively addressing challenges in relation to recruitment and retention of midwives.
"The use of agency staff and extra shifts will reduce as the workforce strategy takes effect," she said.
"The workforce strategy includes a focus on supporting graduates, as well as attracting experienced midwives and consequently improving the skill mix."