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Monday, 7 September 2009
Page: 8636


Mr HAWKE (1:12 PM) —I rise today to support the thousands of women who have turned up to this parliament to protest, not to celebrate, the government’s proposed changes in this legislation that is before us today. The member for Fremantle gave a dry account of the bureaucratic processes of government, but I think she did outline a fantastic case as to why the health minister has got this legislation wrong and indeed ought to reconsider the position of the government in relation 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.

The health minister has temporarily reversed her position on midwives in terms of homebirths. What we see there is an attempt by this government to acknowledge that they have indeed got it wrong. It is the case that only 0.2 per cent of births in Australia at the moment are homebirths. That is a very small proportion of births in this country, and yet when you look around the world the proportions are much, much higher. In the Netherlands, it is 30 per cent; in New Zealand, seven per cent; in the United Kingdom, 2.7 per cent—and this has been rising since 1988; in Australia, of course, 0.2 per cent; and in the USA, 0.6 per cent.

So I find it hard to understand why the government would introduce legislation which proposes that midwives who are present at a homebirth are engaged in some sort of criminal activity—and that is what it would become under this legislation. There would be a $30,000 fine, which is an odd signal to send to a professional midwife with their experience and their talent. I have met many midwives. Midwives who attend a homebirth would suddenly be guilty of a crime. I think this overlooks a series of very serious factors, including the fact that homebirths have been conducted throughout the centuries as a matter of course in human nature. And yet today we have only 0.2 per cent of births in Australia conducted in this fashion.

I cannot understand what problem the government is trying to solve. Of course the government says that this was an unintended consequence of this legislation. Indeed, it is the case that many midwives and nursing practitioners do support a national registration scheme. This is progress. Providing for the indemnity of midwives is a very important matter and something which all members in this place would agree upon. However, when you consider how small a fraction of births homebirthing represents, why exclude this category of activity from the legislation? Indeed, why then go further and say that homebirthing would become a crime under this legislation and midwives who were engaged in it would be guilty of a crime when it is a valid choice for an expectant mother to make?

I have had mothers from my electorate approach me and they are very passionate about the reasons why they may choose to have a homebirth. I find their reasons to be quite acceptable. The majority of people would also find those reasons to be quite acceptable. Sometimes it can be that they have had a very bad experience in the hospital system. I find that to be a valid argument. There are people who go through the hospital system who have genuinely bad experiences. Therefore, it may be the case that a person feels more comfortable in taking a homebirth option.

If you look at all the experience around the world, the argument that homebirth is somehow more risky does not seem to bear any significant weight when it is examined. In the United Kingdom, the largest study of its kind found that, for low-risk women, giving birth at home is as safe as doing so in a hospital with a midwife. The UK has a very workable scheme in place, which I think the government here ought to examine in relation to this legislation. This report did raise the issue of hospital transfers and noted that once complications arise after birth then the issue of transferring into hospital becomes more serious. But the experience of the midwives is such that, when a complication arises, they are the best placed people to determine when hospital care is needed. But, at the time of birth and in the arrangement of birth, there is no difference between hospital care and homebirth care, and that is the experience in the modern practice of this activity.

Therefore, it is mystifying that the government has taken this approach. I think it is very valid for people to be concerned and for women to be here today protesting outside the parliament in support of this. I get the sense that most people in the community accept that there ought to be this choice and that it is valid for a person to choose to have their own midwife present at their homebirth. Not knowing a lot about this topic and having spent time with experienced midwives who visited me, I can tell you I felt a lot more confident about it. Hearing from the women who had been through multiple homebirths with no complications reinforced to me the idea that there is just the same level of risk. When we consider that this is such a small fraction of all births, I cannot understand what the government is afraid of in relation to providing for extra indemnity insurance protection for this category of birthing. We have not heard any good arguments to date in relation to that matter. It may be something for the government to introduce as talking points so that their backbenchers could read them out for us, and then we may have an understanding as to why they specifically would seek to exclude homebirthing from professional indemnity insurance for midwives.

One of the government speakers, the member for Shortland, lamented the Howard government’s approach to this area, but we know that, if you look back in time after the collapse of HIH insurance, the availability and affordability of insurance in Australia went through a complete and utter overhaul. The member for Shortland ought to be very careful about saying that the Howard government did not support homebirthing because all the types of insurance available had to be re-examined and redefined after the collapse of that major insurer within this country.

Today I do not wish to speak for too long in relation to this topic except to record my absolute support for the right of a woman to have choice in her birthing options. In this case, the government needs to seriously re-examine its legislation because of the backflip that we have seen in the last week, saying that they will delay this by two years. The member for Fremantle described it as a ‘medium-term option’. Two years is not a medium-term solution to this problem. It is a very short-term solution. It puts at serious risk the professional and experienced midwives who attend homebirths. For them to then say to mothers, ‘I do not have insurance,’ and therefore raise a spectre of doubt in relation to their activity is, I think, an unacceptable outcome. I do not think this is a medium- or short-term solution. I think we need to look at something better.

If you look at the data or the facts from around the world, with such a small minority of women taking this option up in Australia, the government ought to seriously consider extending professional indemnity insurance to this field of endeavour—of course along properly conducted lines and of course with due examination of a register of women who are professional midwives. I think all members accept the need for those qualifications and that level of scrutiny but I do not see this as a major policy challenge. I do see this as a deep flaw within the government’s approach in relation to these bills in front of us and I would ask that the government seriously reconsider its position in relation to this legislation.