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PO Box 356, Dingley Village, Victoria, 3172, Australia
T: +61 3 9552 0000 F: +61 3 9558 1399 E: [email protected] W: www.sonographers.org ABN: 64 991 983 051
24 January 2018
Family and Community Development Committee
Parliament of Victoria
Spring Street
EAST MELBOURNE VIC 3002
Dear Committee Secretary,
Re: Senate inquiry perinatal services in Victoria
The Australasian Sonographers Association (ASA), the peak body for sonographers in Australasia,
welcomes this inquiry into perinatal services in Victoria.
In most developed countries 90% of women have at least one ultrasound during pregnancy. In Australia
sonographers have a critical role in ensuring expectant mothers have access to quality medical
diagnostic ultrasound for their antenatal care and provision of perinatal services. The patient experience
is also greatly influenced by the sonographer, particularly where expectant mothers are anxious due to
previous perinatal loss, or as the first point of identification of fetal anomalies.
Please find following the Australasian Sonographers Association’s submission to the Family and
Community Development Committee which outlines some risks and concerns the ASA has around the
provision of perinatal services in Victoria. The ASA also seeks, in no particular order, the following
recommended actions to improve the health, care and wellbeing of mothers and babies in Victoria
during the perinatal period:
• That training is made available for all health professionals, including sonographers, in
communicating adverse results of medical diagnostic ultrasound.
• The Victorian Government recognise the essential role sonographers have in providing
perinatal medical diagnostic ultrasound, and to receive positive perinatal care.
• The Victorian Government re-engage with the ASA, ultrasound industry and educators for
solutions to the dire and persistent sonographer workforce shortage in Victoria.
Please do not hesitate to contact us if you require any clarification on the following information or if we
can be of further assistance with this important work.
Your sincerely,
Dr Jennifer Alphonse PhD
President – Australasian Sonographers Association
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The Australasian Sonographers Association submission to the Family and Community
Development Committee inquiry into perinatal services in Victoria
Dated: 24 January 2018
On 16 September 2015, the Parliament of Victoria requested the Family and Community Development
Committee consider the current situation relating to the health, care and wellbeing of mothers and
babies in Victoria during the perinatal period, and report back to the House by 30 June 2016. This
reporting date was first extended to 8 December 2017, and most recently again to 31 March 2018.
The terms of reference include considering:
1) the availability, quality and safety of health services delivering services to women and their
babies during the perinatal period;
2) the impact that the loss of Commonwealth funding (in particular, the National Perinatal
Depression Initiative) will have on Victorian hospitals and medical facilities as well as on the
health and wellbeing of Victorian families;
3) the adequacy of the number, location, distribution, quality and safety of health services capable
of dealing with high risk and premature births in Victoria;
4) the quality, safety and effectiveness of current methods to reduce the incidence of maternal and
infant mortality and premature births;
5) access to and provision of an appropriately qualified workforce, including midwives,
paediatricians, obstetricians, general practitioners, anaesthetists, maternal and child health
nurses, mental health practitioners and lactation consultants across Victoria;
6) disparity in outcomes between rural and regional and metropolitan locations; and
7) identification of best practice.
Sonographers are the allied health workforce essential to the delivery of medical diagnostic ultrasound
in Australia. Please find following a submission from the Australasian Sonographers Association, the
peak body representing sonographers in Australasia, to these terms of reference.
About the Australasian Sonographers Association
The Australasian Sonographers Association (ASA) is the peak body and leading voice for sonographers
and leads our profession in delivering excellence in sonography for the community.
The ASA has been representing Australian sonographers for over 25 years and promoting patient
access to safe and quality medical diagnostic ultrasound by advocating for the role of sonographers in
the healthcare system, promoting best practice in medical sonography and providing sonographer
education and research.
With over 5,000 members and financial membership of more than 70% of Australia’s sonographers, the
ASA has a significant role in supporting and advising the profession on the highest standards to provide
the best possible medical diagnostic ultrasound for patients, and represents the profession on the
myriad of issues within medical ultrasound and the broader healthcare sectors.
Page 3 of 5
1) the availability, quality and safety of health services delivering services to women and their babies
during the perinatal period
Recommended action:
• the Victorian Government recognise the essential role sonographers have in providing
perinatal medical diagnostic ultrasound, and to receive positive perinatal care
Sonographers are integral to the availability, quality and safety of health services provided to women
and their babies during the perinatal period. It is disappointing that the terms of reference to this inquiry
did not expressly recognise the sonographer profession as a described workforce required for the
provision of perinatal services.
Access to quality medical diagnostic ultrasound has a critical role obstetric care1. In the last financial
year almost 1.2 million referred perinatal medical ultrasound services were provided to Australian
women, more than a quarter of which were provided in Victoria2. Sonographers would have been
responsible for the provision of a significant number of these perinatal medical diagnostic ultrasound
services.
Over the last 40 years, ultrasound has become an increasingly important part of diagnostic medicine,
making significant contributions to patient care3. In obstetric medicine ultrasound screening is now a
routine part of antenatal care and provision of perinatal services. It offers enormous benefits providing
useful diagnostic information so that fetal and maternal health may be better assessed and managed4.
Most pregnant women will initially encounter a sonographer in their first trimester to establish viability or
confirm gestational age or in second trimester during an ultrasound examination for fetal morphology
and placental localisation5. Sonographers play a critical role by providing perinatal medical diagnostic
ultrasound services such as screening for fetal anomalies and monitoring development. Sonographers
support and inform other perinatal care providers and patients with high-risk pregnancies6. Sonographer
provided medical diagnostic ultrasound also has a key role for expectant parents and their families
establishing and providing a positive pregnancy experience7.
Unfortunately, there are some critical pressures on the sonography profession which have the potential
to impact patient access to quality perinatal medical diagnostic ultrasound services. These include the
significant sonographer workforce shortage (refer p4); and ensuring sonographers and other health
professionals providing perinatal services have appropriate training and support, particularly in
communicating adverse medical diagnostic ultrasound results (refer p5).
1 Edvardsson K, Mogren I, Lalos A, Persson M, Small R. A routine tool with far-reaching influence: Australian midwives’ views on the use of ultrasound during pregnancy. BMC pregnancy and childbirth. 2015 Aug 27;15(1):195. 2 Medicare Item Reports. Referred perinatal ultrasound MBS items july 2016 – June 2017. 3 Fleming JE, McNay MB; Yorkhill NHS Trust, Glasgow, UK. Forty years of obstetric ultrasound 1957-1997: from A-scope to three dimensions. Ultrasound In Medicine & Biology [Ultrasound Med Biol] 1999 Jan; Vol. 25 (1), pp. 3-56 4 Women’s Health Committee. Position Statement on the appropriate use of ultrasound. RANZCOG, AU. Nov 2015 5 Women’s Health Committee. Routine antenatal assessment in the absence of pregnancy complications. RANZCOG, AU. Jul 2016 6 Alfirevic Z, Stampalija T, Dowswell T. Fetal and umbilical Doppler ultrasound in high‐risk pregnancies. The Cochrane Library. 2017 Jun 13. 7 Bossio, G. Ultrasounds Are a Family Affair, But This Hospital Is Planning To Take That Experience Away. Baby Gizmo. Aug 2017 https://babygizmo.com/ultrasounds-family-affair-hospital-planning-take-experience-away/amp/
Page 4 of 5
5) access to and provision of an appropriately qualified workforce, including midwives, paediatricians,
obstetricians, general practitioners, anaesthetists, maternal and child health nurses, mental health
practitioners and lactation consultants across Victoria
Recommendation:
• the Victorian Government re-engage with the ASA, ultrasound industry and educators for
solutions to the dire and persistent sonographer workforce shortage in Victoria
The shortages of sonographers have persisted for more than a decade8. This issue exists in all parts of
Australia, however is more pronounced in rural and remote areas.
Patient access to quality medical diagnostic ultrasound is crucial to the health care outcomes of
Australians; particularly in assuring and directing services for the health, care and wellbeing of mothers
and their babies. Many perinatal services rely on access to qualified and experienced sonographers to
provide medical diagnostic ultrasound throughout pregnancy.
The singular biggest barrier to meeting the sonographer workforce needs is the lack of available clinical
training places. Medical diagnostic ultrasound is extremely operator dependent. To deliver uniformly
quality medical diagnostic ultrasound services in Victoria there is a need for access to well-trained
sonographer professionals. There are a number of academic courses available to student
sonographers, including two and three-year postgraduate diplomas and a four-year comprehensive
course. However, the bulk of the student training needs to be conducted in a clinical setting, and the
places available for this training are rapidly diminishing.
Training of sonographers is expensive for the clinical site and the individual sonographer. A crucial part
of qualification for trainee sonographers is the requirement to undertake at least 2,000 hours of clinical
practice. It takes time to train and supervise student sonographers, and the private practices where
many of services are provided can no longer afford to carry this cost without support.
Many other health professions benefit from financial support from both state and federal governments to
workplaces that provide clinical training. Across 2014 and 2015 the ASA collaborated with the Victorian
Government to develop a series of options to address the critical workforce shortage in Victoria9.
Unfortunately, there has been no implementation of any of the options developed, or any further
progress with this work.
The ASA requests the Victorian Government re-engage the ASA, medical diagnostic ultrasound industry
and educators, and commit to solutions to address the dire and persistent sonographer workforce
shortage in the state.
8 Department of Employment. Labour Market research – Health Professions Australia 2017. Australian Government, Canberra. ISSN: 2203-9619 9 DHHS. Medical radiations and imaging technology workforce strategy: Strategy plan to enhance supply, recruitment and retention in the medical radiations and imaging (allied health) workforce from 2013 to 2017. Victorian Government
Page 5 of 5
4) the quality, safety and effectiveness of current methods to reduce the incidence of maternal and
infant mortality and premature births; and 7) identification of best practice.
Recommendation:
• that training is made available for all health professionals, including sonographers, in
communicating adverse results of medical diagnostic ultrasound.
Many women have a positive experience during an obstetric medical diagnostic ultrasound, however
women who have experienced a perinatal loss have increased anxiety and decreased attachment
during subsequent pregnancy compared to women of similar gestation with no history of loss10.
The psychological burden on women undergoing prenatal diagnosis, especially in tertiary referral
centres, has been equated to patients with a major depressive episode11. Miscarriage (pregnancy loss
prior to 24 weeks) rates vary but are said to occur between 12-22% of pregnancy and the occurrence of
depressive disorders and anxiety post-miscarriage are reported to range from 3-51%12.
Although the benefits of medical diagnostic ultrasound during pregnancy are well known13 there is also
evidence linking the benefits of ultrasound and the relationship between maternal anxiety during
pregnancy, poor perinatal history, prenatal diagnosis and maternal bonding14,15. The patient’s
experience during an ultrasound scan, especially in the event of a lethal fetal diagnosis, is greatly
affected by the sonographer providing the medical diagnostic ultrasound 16.
There is a genuine need to improved ultrasound training for the sonographers to deal with miscarriage,
perinatal loss, maternal anxiety and delivering bad news. There is significant evidence of the negative
impact of poor handling of communicating medical diagnostic ultrasound results has on expectant
mothers and families, especially where there are fetal anomalies17. Without this there is a risk that
Victorian expectant mothers’ health, care and wellbeing cannot be assured. This need to provide
training in looking after patients after adverse ultrasound findings extends to all health professionals
involved in the provision of perinatal services.
10 Armstrong, D., & Hutti, M. Pregnancy After Perinatal Loss: The Relationship Between Anxiety and Prenatal Attachment. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 27(2), 183-189. 1998 11 Leithner, K., Maar, A., et al. Affective state of women following a prenatal diagnosis: predictors of a negative psychological outcome. Ultrasound in Obstetrics and Gynecology, 23(3), 240-246. 2004 12 Tsartsara, E., & Johnson, M. P. The impact of miscarriage on women's pregnancy-specific anxiety and feelings of prenatal maternal–fetal attachment during the course of a subsequent pregnancy: An exploratory follow-up study. Journal of Psychosomatic Obstetrics & Gynecology, 27(3), 173-182. 2006 13 Edwards, L., & Hui, L. First and second trimester screening for fetal structural anomalies. Seminars in Fetal and Neonatal Medicine. 14 Ji, E. K., Pretorius, D. H., Newton, Ret al. Effects of ultrasound on maternal-fetal bonding: a comparison of two- and three-dimensional imaging. Ultrasound in Obstetrics and Gynecology, 25(5), 473-477. 2005 15 Brisch, K. H., Munz, D., et al. Effects of previous pregnancy loss on level of maternal anxiety after prenatal ultrasound screening for malformation. Journal of Loss and Trauma, 10(2), 131-153. 2005 16 Denney-Koelsch, E. M., Côté-Arsenault, D., & Lemcke-Berno, E. Parents’ Experiences With Ultrasound During Pregnancy With a Lethal Fetal Diagnosis. Global Qualitative Nursing Research, 2015 17 Walker, L V. Miller, V J. Dalton, V K. The health-care experiences of families given the prenatal diagnosis of trisomy 18. Journal of Perinatology 28, 12–19 (2008)
