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Monday, 7 September 2009
Page: 8720


Ms SAFFIN (7:11 PM) —I speak in support of the cognate bills: 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. One of the key things here is that maternity care is being brought into its rightful place of primary care: for the first time ever we are going to provide Medicare funding for midwives. That will increase opportunities for women to have more choice about how they have children. That is one of the significant features of the package of bills around maternity care. I am going to talk about homebirths, particularly from the perspective of my seat but also from that of the North Coast Area Health Service, which is broader in area, the number of homebirths, the options that we have and the issue of professional indemnity insurance.

In the budget, the government committed $120.5 million over four years to maternity services. I commend them for that and commend the Minister for Health and Ageing. That was for maternity services reform and, over four years, $59.7 million of that is to expand the role of nurse practitioners. This is where the expanding role of midwives comes in. These bills will support the inclusion of nurse practitioners and midwives under the Medicare Benefits Schedule, the MBS, and the Pharmaceutical Benefits Scheme in line with these budget measures of 2009-10. They will also enable the establishment of a professional indemnity scheme for eligible midwives, which is critical to supporting the new MBS and PBS arrangements.

There are a number of independent midwives who practice, and do not have professional indemnity insurance. My memory is that professional indemnity insurance was taken away in 2001. When I say ‘taken away’, the insurers would no longer provide that. I do remember a particular case to do with an obstetrician, and I think there was a payout of around $12 million, or something like that. I remember it at the time and it has been written about again recently. I know it was after that time that professional indemnity was taken away.

I listened to speeches and contributions about midwives and homebirths today from the other side, and the first one I heard was the member for Groom. He said, ‘Well, you know, it’s been put off for two years.’ He said if he adopted a cynical view it could be that it was put off until after the next election. I have to say, on his comments, there is no cynical view about this. Since I came into this place in 2007 I have been in conversation with the Minister for Health and Ageing and other members of government about the issue of midwives, and particularly midwives and homebirths. Minister Roxon has been trying to find a way to address the issue of midwives who do homebirths and professional indemnity. The scheme that is being introduced, and this great reform that is being introduced, is part of a COAG agreement. So it is the federal government but it is with all the states and territories. It takes some doing to get that negotiated with the different schemes that operate across each state and territory.

I am pleased to say that I have stayed in that conversation with her up until even last week and continuing this week. Last Friday she was able to secure the agreement that made sure the professional indemnity issue would not be a barrier for the independent midwives. They practise now without it and most of them that I know do advise the women, the pregnant mothers, who are giving birth. A lot of women in that situation do sign the disclaimers. I have to commend her for that agreement because that was one of the things that was being worked towards.

I just want to say something else about professional indemnity. I once was the president of a health service, North Coast BreastScreen. The program was the North Coast Breast Screening Program. When that was introduced it was part of the national mammography screening program. Every other service in Australia that provided mammography provided it through a health service; thereby it attracted immediately all the professional indemnity. Ours did not. It was a non-government organisation.

We were incorporated under the Associations Incorporation Act. This was done with the permission of the federal and state ministers. There were certain agreements about what we would trial for attracting certain women, and particularly Indigenous women, into that scheme. So we did not have professional indemnity and I, as the president of that organisation, had to negotiate to get professional indemnity because we had to be covered. I did that with AMP. It took some time. It had to go to the national board—I think they had a meeting in New Zealand—and we actually got it. So I am speaking with a little bit of experience in the health field in getting that professional indemnity. It was not easy and I know it is not easy now, for all sorts of reasons. But that is why we need time, and the minister has got that time so that a whole lot of options can be looked at. That is just one option that I was able to do with that particular service, but we had to jump through a lot of hoops to get it. We had to undergo certain training—me included—that normally only medical people would go through and there were certain protocols we had to adhere to.

I saw that the agreement that the minister reached with the states and territories on Friday through COAG also referred to some of those protocols having to be in place. There would be a requirement that the independent midwives would notify women that they did not have professional indemnity insurance. As I said, most of them that I know do that. So they are really reasonable measures that have been introduced, alongside this period of two years, which gives us some time. On that particular issue, I see that as a good step forward.

Also, this is about accreditation and registration. This is one of those issues that has been lingering for a while. It has been in the mix but has never got to a point where we could have it. The minister has done that and there will be at least 10 areas that will come into that national scheme. That is a good thing. So there are a whole lot of good things about this bill. It was not that we were going to exclude independent midwives; it was about how we can find a way through this.

I also want to talk a little bit about the figures in my area and say that there was a review of homebirthing in the Northern Rivers health catchment. That was undertaken in 2004 by the clinical midwife consultant Sue England, who was with the North Coast Area Health Service. She is now with World Vision. She is a very experienced midwife, with experience in many settings. There was also a paper prepared by M Spain and H Gulliver in 2005-06 that looked at figures in our particular area. I will quote from their paper—and this comes from that report Sue England prepared. It says:

The Northern Rivers Area Health Service—

as it was then—

has a significant home birthing community and records the highest homebirth rate in the state outside of metropolitan Sydney. To date, reliable data on the numbers of women choosing to birth at home has been difficult to quantify. The New South Wales Mothers and Babies report recorded 99 homebirths in the state, or 0.1 per cent of total births, and in the Northern Rivers 14 homebirths were recorded—0.5 per cent of total births. The real figure for the Northern Rivers Area Health Service is more likely to be around 100—approximately three per cent—based on advice from many sources accessed confidentially during 2004. Thus we can assume that this area has a significant home birthing community and will continue to do so.

Further in the paper it says:

In 2004 a total of 58 births, and an increase in 2005 to a total of 65 births, were registered to have occurred out of hospital.

This is from the register of births, deaths and marriages dated 2004. The paper goes on to say that, at the time the paper was written in 2004:

An average of three per cent of births in the North Coast Area Health Service occur out of hospital. This compares with the New South Wales state average of only 0.1 per cent of births occurring out of hospital in 2004.

My point is that there are a significant number of women who have their babies out of hospital settings as homebirths. I would like to quote from a couple of the women who are active in that area. I have an email, saying:

Dear Janelle,

Just wanted to say a big thanks to you and your staff for helping me to participate in yesterday’s consultation with the Prime Minister and Minister.

That is, Minister Roxon and Minister Elliot.

I thought it was a really productive few hours. I could sense they were very keen to listen and were very open to hearing new, innovative ideas.

It was a health consultation and the writer was there with the express purpose of talking about independent midwives and where the legislation was going. That has been the approach all the way through.

I would also like to mention that in my area, in Lindendale, which is just outside of Lismore on the road to Wollongbar, Alstonville and Ballina, there is a Natural Birth Education and Research Centre Inc. Women go there for homebirths in a supported setting. It is run by Margaret Spain. She is a midwife of longstanding and someone I have worked and collaborated with in the area of homebirths. I will talk a little bit about the centre. They have collected five years of data outcomes of their service, and the services at the centre have a clear standard of practice. Women receive information on the screening criteria and the knowledge that primary midwives are not insured. The centre has volunteer public liability insurance. They have a referring obstetrician who supports the centre, midwives and clients. He is informed of the outcome of each birth that occurs at home, hospital or the centre. All clients are required to book into Lismore Base Hospital should a transfer be required and all receive the appropriate 28-week and 36-week pathology.

The Natural Birth Education and Research Centre has found the greatest deterrent to women receiving care through their services is financial because there are fees if you want to birth in such a centre. That is one of the issues that we are looking at. The centre has provided to me—and I have given it to the minister—a proposal about how the centre could operate in one of the models of care around midwifery. I note that this is not a new issue. The issue of midwifery has been around for a long time, as has the issue of women giving birth at home—or homebirths, as we call them. It is an issue of choice. It is not everybody’s choice but it is about choice. We have to make provision so that women can have that choice. I know that some of the medical profession say that there are no safe births outside the hospital; they want them to happen at the hospital. But when I look at the figures of the Natural Birth Education and Research Centre, all births there have been safe. When I look at figures from New Zealand and the Netherlands, where it is more normal to have homebirths, I do not see a problem there either. It is just that we operate differently. Everything that I have read shows that if women have that choice, they will take it up because having a baby does not have to be a medical event. It is a pretty natural thing that happens.

Turning specifically to the three bills, I would like to make a few points about the particular arrangements regarding midwives. For midwives to be eligible to participate in the new arrangements they will need to meet advanced practice requirements and have collaborative arrangements with doctors. A lot of them already do. These requirements and collaborative arrangements are being developed in consultation with midwives, doctors and other stakeholders. The reform initiatives supported by this legislation allow for this incremental reform within a strong framework of quality and safety. It is expected that around 700 eligible midwives will be participating in this measure over the next four years, and another 700 eligible midwives being involved in the scheme is a good thing. I have not heard any midwives object to being asked to report each homebirth, but there has not yet been a scheme or a system to allow them to do that. The Natural Birth Education and Research Centre in my area which I talked about do that. They have worked out that system with the local obstetrician, so there are ways that that can happen.

In supporting this reform, it was really pleasing that Minister Roxon initiated the Maternity Services Review, because it was really important to have that. We have had many reviews in particular areas. I have read so many reviews about birthing and about maternity. A lot of them are very informative and useful, but there is not one that looks at it nationally with a view to having a national scheme in place. That is the great thing about this one, and it was important to do it. I know that the Maternity Services Review did not recommend professional indemnity for midwives who do homebirths but, even though it was not recommended, it is one of the things that the minister has taken on in not only responding to it, but recognising and having knowledge of the situation in Australia—that is, a small number of independent midwives, a small number of homebirths. If they were brought into a system, if there were more choices available and if there were more financial incentive around it, I am absolutely certain, after everything I have read on this topic over the last 30 years, that a lot more women would choose to have either homebirths or births in centres such as the one run by Margaret Spain in my area at Lindendale that I described. I see these bills and this process as a way forward for all of that. It is a way forward for great reforms and, in commending the bills to the House, I also commend the work of the minister.