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Thursday, 20 August 2009
Page: 8527


Mr SIMPKINS (1:17 PM) —It is not my intention to speak for very long, but I will make a contribution to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009. As a father, I have some appreciation of the subject of childbirth, but I am also thankful for not having had to have gone through the process. Not only do we as men not have to endure the pain—or as the medical professionals might call it, ‘discomfort’—but we do not have to endure the hormonal challenges that make a woman’s pregnancy even more of a difficult experience. What I do recall is the sense of fear I had at the birth of my two daughters as to whether everything would be all right. The experience for a father is that of physical detachment, but with a great degree of emotional concern. What is abundantly clear is that a man faces very little in comparison to the woman. Therefore, in my comments today I will seek to empathise, but I could never speak with the authority that comes with a woman’s experience and point of view regarding midwives and the bearing of children. Nevertheless, I take this opportunity today to make some comments on these bills. Like many others in this place, I support them in the main, but there are elements within this policy that I cannot say that I wholly support. However, I will be a little more specific later.

Before I go to the substance of the bills, I would just like to reflect on my limited but nevertheless valid experience in two hospitals and with the midwives at those two hospitals. My eldest daughter, Emily, was born in 1998 at the John James Hospital not far from here when I was posted here in Canberra in the Army. I was keen for Emily, being our first child, to be born in a hospital to ensure that, if anything went wrong, she and my wife, Kelly, would have access to immediate and substantial care. This was in spite of the fact that there was no indication of any likely problems. Being careful with my children’s safety began then and explains why later, whenever Emily or her sister, Rebecca, were climbing on play equipment when they were toddlers, I was always right behind them, ready to catch.

Similarly, despite no indications of any risk, there was no doubt in my mind or my wife’s mind that our second daughter would be born in hospital as well. My second daughter, Rebecca, was born at Glengarry Hospital in Perth in 2002. Our experiences of both of these hospitals were outstanding. The midwives did all the medical and professional health work to support my wife in the delivery and in the days afterwards. I therefore have the very highest confidence in the skills, training and professionalism of the midwives and the nurses that we had contact with in those two hospitals. In our local area in Cowan I have never heard a complaint about the work of nurses. Indeed, that confidence extends to the Joondalup Health Campus, which is the major hospital in the northern suburbs of Perth.

That being said, we never considered homebirth, and if we were intending to have more children we would still not consider homebirth. That is, above all, a matter of choice. I believe very much in free choice and the making of decisions by the mother and the father with due regard to and acceptance of the risks that are involved. I repeat that it is not a decision I would make, but there are very many people who stand by the advantages of homebirth. If that is a decision they wish to make, then no government should make that impossible or harder than it should be. Clearly then, while I support the majority of the changes foreshadowed in these bills and plans to come from the government, I see that amendments or changes would be required to those plans to maintain the options that some parents seek for having their children born at home.

I will now make some specific comments about the bills. As I previously stated, I support the majority of the items in these bills. Access to doctors, access to diagnostic tests and access to treatment options are clearly detrimental to the best possible health outcomes if they cannot be achieved within reasonable time frames. The authority of midwives and nurse practitioners to assume responsibility for some of these needs should allow better time frames for action on health concerns.

The legislation will give registered midwives and nurse practitioners the capacity to order certain diagnostic-imaging and pathology tests, for which a Medicare benefit can then be paid. The legislation will also allow these midwives and nurse practitioners to prescribe certain medicines under the PBS. The midwives and nurse practitioners will also, when they are working in collaborative arrangements with doctors, have new Medicare items and referrals listed under the Medicare Benefits Schedule. The bills that cover indemnity insurance matters will allow the Commonwealth to reach a contract with an insurer through a national tender process to provide indemnity insurance for midwives operating independently.

Clearly there are significant changes provided for in these bills. It is known that not all stakeholders support every part of the legislation. That is why the coalition supported the consideration of changes by a Senate committee. Unfortunately, the workload and number of submissions, being more than 200, have caused a delay in the finalisation of the report by the Senate committee.

I will now take the opportunity to mention some of the comments made by stakeholders with regard to these bills. I note that the AMA disagree with aspects of these bills, particularly where midwives and nurse practitioners would have access to the MBS and the PBS. They also believe that patient care should be coordinated by a medical practitioner. However, given the decision to pursue these changes, they want to have involvement in the details of the regulations to be created. On the other hand, the Rural Doctors Association have broadly supported the changes regarding access to the PBS and the MBS. However, they also ask for controls and guidelines to ensure good communication between doctors and midwives and nurse practitioners. Both the AMA and the Rural Doctors Association oppose homebirth. The Australian College of Midwives support the bills. However, they want provisions to allow homebirth options. It is worth noting that the college recognises that homebirth is not appropriate in complex or higher risk cases.

The issues raised by stakeholders seem to be consistent. The points raised generally support midwives and nurse practitioners having access to the PBS and the MBS under certain controls and provisions. The division comes with the increased physical separation between the activities of midwives and nurse practitioners and those of doctors. Doctors are less inclined to support midwives and nurse practitioners providing patient care when doctors are not in the immediate area, which explains their complete opposition to homebirth under the supervision of midwives.

The government have negotiated the middle path in this situation with the stakeholders. They have sought compromise on both sides. Where I object is that the choice of homebirth is basically prohibited under plans regarding registration and accreditation. I reiterate that my wife and I would never have sought the homebirth option, but some women do. If they examine and are willing to accept the risks involved in taking that decision then such a choice, which currently exists, should never be taken away from them. It is my view that the government should reconsider their registration and accreditation plans.

To conclude, I thank my constituent Kiera Pedley and others within the electorate of Cowan for bringing to my attention their concerns and perspectives on homebirth. As I said right at the start, childbirth is certainly not an experience that we men ever have to go through—and I for one am pretty happy about that! Provided women understand the risks and the challenges of homebirth then they should always have that choice, and we on this side will always support that choice.