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Monday, 7 September 2009
Page: 8642


Mrs GASH (1:36 PM) —I rise to speak to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and cognate bills in the interest of supporting freedom of choice for women. Whilst I applaud the move to expand the role of nurse practitioners and midwives, I cannot support the government in its long-term plans to exclude those who wish to assist in homebirths from the compulsory national registration and accreditation requirements, effectively disallowing the practice. It is pleasing to see that the Minister for Health and Ageing, Nicola Roxon, has recognised that she has made a big mistake on this issue in the past few days and offered some hope to homebirthing mothers and experts by allowing a two-year exemption from indemnity insurers for privately practising midwives, but it does not go far enough. While this does give the government two years to do its research and follow in the footsteps of other First World countries on this issue, there is still a long way to go in ensuring long-term certainty for private midwives and pregnant women.

I have been approached by many of my constituents as this debate has unfolded, who question why it is okay for a woman to choose whether she will abort a pregnancy, and how or whether she will undergo a caesarean or breastfeed, but not where she will give birth. Excluding midwives from indemnity insurance registration after a two-year indemnity period following the introduction of the national registration and accreditation in July 2010 will most certainly drive the practice of homebirth underground, with a potentially fatal risk to mothers and their babies.

Mums have reserved the right to give birth in their own home with experts they trust and feel comfortable with for hundreds of years. There is no one-size-fits-all approach to birth and the government should not legislate that there be just one or effectively make this so by putting question marks over the long-term viability of the practice and by refusing to offer Medicare support in any way. The law needs to take into account the feelings or preferences of women, who are ultimately the ones that will endure giving birth and live with the result. Over 18,000 women believe that a woman who is capable of making an educated decision about her child’s birth, and who is well aware of her options, should not be prevented from homebirthing by a well-meaning third party. This figure was found on the Homebirth Australia website, where 18,197 women have signed a petition to block the legislation that we are discussing here today.

While the number of homebirths only represents less than one per cent of all births in Australia, or approximately 700 births per year, this unique option still has a lot of support from women who reserve the right to choose, depending on their circumstances as the practice can also be quite expensive with no Medicare or private health fund rebates. Surely in this day and age of advanced skills, knowledge and technology it is possible to assist a woman in giving birth where she is most comfortable. There are several women in my area who are well qualified and who have set up their own private practice in this industry, providing a quality service to women and families in the Shoalhaven who choose personal care in their own homes. Moves to prevent these women from practising in the long term not only directly affect their business—the source of their wellbeing and passion—but also severely disadvantage the many women who would no longer be able to call on their services.

Pregnancy can be a time of intense stress and worry. Many women need the support that independent services provide, and any effort to make their experience as positive as possible is certainly worth while. In my view it is important for us to look at all the facts during this debate, as I would hate for us to perpetuate an existing culture of misinformation and a misunderstanding which often overrides the views of the very people that this legislation affects most, and that is women.

Some women may not be interested in homebirthing; I did not consider this option to be right for me. But the point is that it is a choice, a choice that women in a developed country like Australia should be entitled to. While the media has been known to focus on negative stories related to homebirthing, there is also ample research that indicates homebirth for low-risk pregnancies is as safe, or safer, than hospital births. All the facts need to be brought to the table in this discussion along with some consideration for all women, who deserve the right to go through the process of birth—a process they will remember for life—in a way they feel comfortable with.

It is actually quite alarming to me that we need to debate the legality of this age-old practice when, as I mentioned earlier, we live in an age of medical breakthrough, highly advanced technology and an accredited knowledge at our fingertips. It almost seems as though we are going backwards. If there are enough women who are always going to choose homebirth in the right situation, why are we not aiding them with the tools that we have? Why is the government leaving the door open to make things harder, as opposed to easier, for these women in the long-term, when the capability is certainly there? No one doubts that safeguards should be put in place; no one doubts that women need to be armed with the right advice and information. But, surely, providing the right resources for women instead of driving the practice underground is a better outcome for everyone involved.

The homebirth model of care has many points worth applauding: many women have reported feeling more prepared, safer and comfortable. I am not promoting it above hospital births, but I am simply pointing out that it is a viable option. This positive feedback highlights the professionalism and care provided by our nurse practitioners and midwives. I have the utmost faith in these professionals, and do not doubt their ability and judgment as the government apparently does. Some of them have helped successfully deliver homebirths for many years. We know that their representative body is extremely concerned about this legislation, warning that it would increase mortality rates, and although Minister Roxon has offered some concession the industry does need long-term certainty.

The Australian College of Midwives would like to see independent midwives exempt from indemnity insurance requirements full stop, not just for X amount of time, or would at least like to see the accreditation extended to them in the long run. This is certainly not an unreasonable request for those qualified homebirthing experts. The government does not have its hands tied: it can better equip women if it chooses. Friday’s backflip shows that the government recognises it made a mistake and, on behalf of the women in my electorate of Gilmore, I certainly encourage it to fully address the matter and not just offer a bandaid solution. The government is already showing some confidence in our Australian midwives and nurse practitioners with an increase in their powers to prescribe certain medicines, but it is treating them with contempt by leaving the door open to prevent those qualified to offer expert assistance in a homebirth from doing so.

I believe this issue boils down to several key factors that cannot be ignored. Firstly, it is about choice and the freedom to choose. Giving birth is a major event in a woman’s life, it affects her body and family for life and there are currently options for women, as it is acknowledged that one size does not fit all. Those options must remain in place for women. They can be added to as breakthroughs in research and technology are found, but never taken away from.

The second issue here is safety. There is a significant number of women who have done their research and have already decided that homebirthing is for them. They may even have been through the process before. These women are going to deliver this way whether they are supported by the government or not and qualified services must be available to them for the long term, without question, to make this practice as safe as possible and to reduce the possibility of unwanted consequences. The third point I emphasise is that our nurse practitioners and midwives are of world-class standard. Their professionalism and track record is the only reason we can have this debate today. I have every confidence in qualified midwives who are homebirthing experts and I stress the need for them to have the freedom to access the resources and services that they need. I am aware that the state Labor government has virtually made us a nanny state in New South Wales, treating the rights of mature adults with contempt, and surely any effort to assist the state government with easing the burden on its overcrowded, understaffed hospitals would be welcome.

Almost every day we read in the media stories about women who are sent home in the early stages of labour until a bed can be made available at a nearby hospital. While I would never denigrate the work of our medical personnel, I do criticise the lack of facilities provided and I certainly think that supporting other viable options such as homebirths would be in the public and government’s best interests. Not all women are happy for choices about their bodies to be left up to others, like the women I visited at this morning’s ‘Mother of all Birthing Rallies’ outside Parliament House. They are passionate about choice, as I am, and I speak for them today. I thank them for travelling from many far and wide places to be here today—it has not gone unnoticed. Well done to you all for being here. Your views have and will continue to be heard by the coalition.