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Monday, 7 September 2009
Page: 8638

Mr ZAPPIA (1:21 PM) —I too rise to speak in support of theHealth 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. This package of bills provides the government’s response to the Maternity Services Review, which I understand considered some 900 submissions. Just before I get onto my remarks on the bills, I will just say in respect of the comments previously made by the member for Mitchell that, even if he believes that the Howard government did not do the wrong thing in not providing professional indemnity insurance to midwives back in 2001 and even if he believes it was simply a case of an HIH debacle, the government had some eight or nine years after that to correct that particular anomaly and, in fact, chose to do nothing. For members to then come into this chamber and say the government ought to do it now raises the question: if it could be done and it was practical for it to be done, why didn’t they do it? They had so many years to do so.

These bills are important legislation because they respond to the Rudd government’s Maternity Services Review. That review was undertaken because there were clearly flaws and problems in the birthing services throughout this country. It was not undertaken just to fill in time; it was undertaken because this government recognised that we could do things better, that we should do things better and that it was time that we did things better. These bills collectively go a long way to in fact doing things better when it comes to birthing throughout Australia.

The bills deliver on the government’s commitment of $120 million over four years to maternity services reform and $59.7 million over four years to expand the role of nurse practitioners. These bills do not make homebirthing unlawful. Importantly, following an agreement reached on Friday, 4 September—only last Friday—between the federal health minister and state health ministers, an exemption will apply until June 2012 for privately practising midwives who are unable to obtain professional indemnity insurance for homebirthing. June 2012 is not two years away; it is almost three years away. It gives ample time to the industry, the government and the state governments to look at what other measures need to be put in place. Three years is not insignificant, and I believe that it is a welcome move on the part of the federal health minister and the state health ministers working together. The exemption will enable homebirthing midwives to continue to provide their services in jurisdictions where that is currently allowed. The exemption comes with conditions requiring full disclosure by midwives that they do not have professional indemnity insurance and consent that each homebirth be reported. Those are reasonable and appropriate conditions to apply in order to get that extension until June 2012.

In summary, these bills implement three key measures relating to eligible nurses and midwives. Firstly, the bills support the inclusion of nurse practitioners and appropriately qualified and experienced midwives in the Medicare Benefits Schedule. Secondly, the bills support the inclusion of those same nurse practitioners and midwives under the Pharmaceutical Benefits Scheme. Thirdly, eligible nurse practitioners and midwives will be able to secure professional indemnity insurance under a government professional indemnity insurance scheme. I note that these measures have the support of both the Australian Nursing Federation and the Australian Nursing and Midwifery Council. I also note that the measures I have just referred to do not generally apply to homebirthing and that there has been some concern expressed by some sectors about that aspect. I understand that some state governments provide varying degrees of support for homebirthing. I also accept that there will be occasions when homebirthing will be a necessity. Overwhelmingly, however, births take place in a hospital because that is where the medical support services are available for both the mother and the child if a complication arises during the birthing.

I am aware that there has been some concern and some opposition to these bills because, as the measures contained within them do not apply to homebirthing, mothers wrongly believe that they are being denied choice. I just want to speak about the issue of choice, because it is an interesting matter. I ask those people who talk about choice: what choice does the newborn child have in the birthing and what rights should that child have? On other matters, I frequently hear members opposite talking about the rights of the newborn or unborn child. Today I have not heard one single member opposite talking about the rights of the newborn child. I accept and respect that mothers have choice, but I think that as a society we should also accept and respect the fact that the newborn child should have rights. If the newborn child is not in a position to express those rights then we collectively, as a society, also have an obligation and a responsibility to that newborn child. It is my view that every newborn child should have the right, wherever possible, to the best birthing services available at the time.

To quote Dr Andrew Lavender, President of the Australian Medical Association in South Australia:

Home birthing may appear to be an emotionally fulfilling option, but history has revealed it as clearly more dangerous for babies and mothers than birth in a hospital.

Current advocacy for home birthing fails to mention that even in highly selected cases—where the birth weight of the baby exceeds 2,500 grams and pregnancy exceeds 37 weeks—the mortality rate for babies is double that achieved in hospital.

It’s impossible to predict or safely manage birth complications such as an impacted shoulder, impaired oxygen supply to the baby, or massive haemorrhage in the home. The safest place to be is in a hospital.

Dr Lavender goes on to say:

Home birthing is a dangerous choice, which pays no regard to the rights of the unborn child to a safe and healthy birth with the best care available.

I am not a doctor and I am not prepared to make judgment on these matters, but I am prepared to say that if the President of the Australian Medical Association in South Australia—who, I assume, speaks on behalf of his profession—makes those statements then we should take note of them.

Enabling nurse practitioners and eligible midwives to prescribe necessary and appropriate diagnostic services or pharmaceutical products will not only ensure that mothers and newborns can be provided with better medical care but free up doctors, most of whom are already working long hours. It is also my view that it will give deserved and long overdue recognition to the nursing and midwife professions. The professional indemnity provided under the bills is essentially a government backed scheme whereby, for any claim between $100,000 and $2 million, the government will pay 80 per cent of the claim and, for claims above $2 million, the government will pay 100 per cent of the claim. Under those circumstances, it seems to me that all taxpayers would expect the government to minimise its risks by not covering homebirthing if the hospital option is available. It seems to me that this cover would not be feasible or affordable if homebirthing had been included.

In 2006, the latest year for which figures are available, there were 269,835 births recorded in Australia. Of those, 97.3 per cent took place in a hospital and two per cent took place in a birthing centre. Only 708 were recorded as deliberate homebirths, which is approximately one-quarter of one per cent of the total births in Australia for the year. What was particularly notable in those figures was that in that same year 886 mothers had intended having a homebirth but 178 of those, or one in five, needed to birth in a hospital, highlighting just how frequently complications arise with birthing. The South Australian government’s Children, Youth and Women’s Health Service estimate that every year around 50 women in South Australia choose to have planned homebirths. Homebirthing is by no means unlawful under these bills, and I understand that the minister is continuing to work with the states and territories on this issue following the meeting and agreement reached last Friday. However, the Maternity Services Review did not recommend that mothers who choose homebirthing should expect the rest of society to bear the additional financial risks that come with it.

I take this opportunity to give special recognition to the Zonta women of Australia, especially Zonta women of the Para District Zonta Club in Adelaide, for the extraordinary support the members provide to midwives, nurses, mothers and babies both in Adelaide and overseas. The club has taken a special interest in supporting birthing services provided at home and abroad. Over the years club members have made and donated hundreds of beautiful baby quilts to local families in need of support. Their support for Third World countries comes through the provision of birthing kits that the club members fund and organise for distribution. Such simple kits can make so much difference to ensuring a much safer birth for mothers and babies in parts of the world where both maternal and infant mortality rates during childbirth are high. This program commenced in 1999 with the provision of 100 kits to Papua New Guinea. Zonta have since distributed in total 340,000 kits to 30 different countries in the Asia-Pacific and African regions. They have worked in partnership with 40 organisations including, since 2004, the federal government’s overseas development organisation, AusAID.

This project, which started small, has grown into the Zonta Birthing Kit Foundation, which runs community development programs where the local government or community establish their own midwifery training programs with the hope that eventually they will source, supply and make their own birthing kits. These kits make such a difference to the health and wellbeing of mothers and children in Third World countries, and I applaud the ambition to educate and empower the local communities to provide their own care and own birthing kits. This level of support and empowerment is a great example of a local community working to assist less fortunate mothers and babies who do not have the same access to maternity services and support covered under this legislation.

I would now like to elaborate on the further support and recognition for nurses and midwives that arise from this legislation. My own state of South Australia has been a leader in the provision of maternity services by midwives and nurse practitioners because of the Alternative Birthing Services Program, which was established in the early 1990s. Birthing units now operate at three of Adelaide’s hospitals—the Flinders Medical Centre, Lyell McEwin Hospital and the Women’s and Children’s Hospital. The consequence of this is that South Australia has a much higher proportion of births in birthing units—around seven per cent annually, compared to a national average of two per cent. The federal government’s Maternity Services Review report found that demand for birthing units is growing. This legislation provides the support that midwives and nurses need to meet this demand from expecting mothers for birthing unit services. As a consequence, we should see the proportion of birthing unit births in other states rise to be closer to that in South Australia.

The organisations representing nurses and midwives have been very outspoken in their support for this legislation. On 13 May, the day after these measures were announced in the federal budget, the Chair of the Australian Nursing and Midwifery Council, Professor Mary Chiarella, said:

The Rudd Government and Minister for Health and Ageing, the Hon Nicola Roxon have shown their support and understanding of the contribution that nurses and midwives can and are making to the health system.

…            …            …

In responding to the Maternity Services Review the Rudd Government has provided greater choice for women in maternity care by providing MBS and PBS for eligible midwives. It also supports midwives in being able to provide women with greater choice through a Government-supported professional indemnity insurance scheme for eligible midwives.

The secretary of the Australian Nursing Federation, Ged Kearney, said:

This represents a new era of health care and is a landmark reform of our health and hospital system.

She also said:

These changes will boost frontline healthcare across the community and make sure that those people who receive health care from nurse practitioners and midwives can do so without facing huge out of pocket expenses.

The support of these key industry organisations for the changes in this legislation shows that the Rudd government has gone about its reform of maternity services in the correct way. As part of the review the government consulted widely with all key stakeholders and the community. The report from the review was made publicly available in February 2009, before these changes were announced in the May budget. The reforms in this legislation will provide greater support and recognition for midwives and practitioners. They will meet the increasing demand for families to utilise birthing unit services. These reforms, arising from the recommendations of the report of the Maternity Services Review, will mean Australia has a stronger and more equitable health system. Rosemary Bryant, Australia’s Chief Nurse and Midwifery Officer, said in her foreword to the review’s report:

There is a clear role for leadership by the Australian Government in concert with the state and territory governments to ensure that Australian women and their babies are provided with the best possible care.

I agree with the sentiments of Rosemary Bryant and I believe that the measures in this legislation are a significant step in creating a health system that provides the best possible care for Australia’s mothers and their newborn babies. I commend the legislation to the House.