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Tuesday, 8 September 2009
Page: 8926


Dr STONE (5:35 PM) —I too rise to talk 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. I am particularly concerned about midwives because they offer, in country Australia, an opportunity for a woman and her partner to have a birth at home—or indeed in hospital, but a birth that is a matter of their choice—where they are perhaps a very long distance from hospital, where there perhaps is not a gynaecologist, an obstetrician or a GP who still assists with births in their community.

There is a real problem with the changes to the legislation that were mooted by the federal minister, which in essence made midwives’ activities unlawful in most of Australia. It was said that you had to have indemnity if you practised as a midwife outside a hospital setting, but as a midwife operating outside a hospital you could not in fact seek and obtain insurance for your work, so both the people seeking the services of a midwife and the midwife were put into an extremely difficult situation.

Hence we had nearly 2,000 people—mostly women with their children but also some of the men who support those women—outside Parliament House yesterday in the rain protesting, saying, ‘This is Australia and this is the 21st century. How come in a country like this any government would choose to drive away from women a choice about where they give birth and how they give birth?’ It was quite an extraordinary circumstance and it reminds you, going right back, of medieval times, when women as midwives were subjected to the most extraordinary prosecution and persecution. You would have thought in the 21st century all of that was behind us but here we have the government of the day trying to say that a woman choosing to give birth at home cannot lawfully be assisted by a trained and highly professional midwife.

There is a lot of nonsense spoken about homebirths being less safe and more likely to have a catastrophic outcome than a birth in a hospital. That is a nonsense proposition given the data that is coming in from various developed countries where homebirths have been practised for a very long time. We know that there are risks associated with childbirth—and those risks, of course, are not eliminated with a homebirth. According to AIHW statistics from 2005, 601 planned homebirths in Australia were reported nationally, representing 0.2 per cent of all women who gave birth. It is a very small proportion but it is an important decision for those women. The highest proportion of homebirths occurred in Western Australia, and 27.1 per cent of women who had homebirths were mothers having their first baby.

A 2008 study of the homebirths of 24,000 women revealed that homebirth is an acceptable option for low-risk women and that it leads to reduced medical interventions. The same data states that planned homebirth—while it is very controversial and often causes great excitement amongst the medical fraternity, who would otherwise be receiving the fees for assisting as gynecologists, obstetricians or general practitioners—is not more dangerous than an in-hospital birth. The rate of infant deaths for both groups—for homebirths and those giving birth in hospital—was similar. In the 2008 study, of the 24,000 women who gave birth no mothers died. The number of babies born in poor condition—in other words, with low Apgar scores—was lower in the homebirth group, and the number of mothers with severe lacerations was lower in the homebirth group.

Midwives in Australia are highly trained and highly professional. They have been practising in association with gynecologists, obstetricians and general practitioners for a very long time, but they also practise alone. In my electorate of Murray there are very highly professional and skilled midwives who offer a private homebirthing service but who find that, even though their clients wish them to be supportive of their births right through to the actual delivery, if the mother presents at hospital the midwife is not allowed to attend to the woman, even though it is her choice and preference to have that midwife with her in the hospital. There is also the extraordinary circumstance that, even if the baby is born without the assistance of a GP, whether it is one who is on duty at the time at the hospital or one who cannot get to hospital in time, the GP is still paid the fee. The private practising midwife certainly does not receive any fee at the hospital.

This is a very serious matter when it is about the choice of women at one of the most important times in their life—giving birth. In Australia we always want to be sure that both the mother and the baby are safe, and it will always be the case that low-risk women will be most likely to have homebirths. But it is also the case in Australia right now that we have only seen a two-year moratorium with the status quo. It is no solution either for the women who wish to give birth at home or for the midwives who are trained to assist them.

We have to have a resolution of this problem once and for all. This government has to accept the fact that highly trained professional midwives should have insurance. They should be able to practise in the way that they do in other countries where homebirthing is understood to be an important alternative to births in hospitals. Midwives should not be treated as weird minority women who are more likely to be out knitting jumpers than attending to women’s needs. This is one of the unfortunate stereotypes that you see coming up again and again. I want to commend the midwives who work in my electorate. They are some of the most dedicated and compassionate women I have met anywhere. They have their patients’ and their babies’ futures always very firmly at the front of their minds as they advise and support women through birth.

Midwives and their clients are deeply distressed at the moment about the fact that there is no solution. Their choices are now even more seriously limited than they were before. We have no increase in gynecologists, obstetricians or GPs giving birth attention. In our region the numbers in those sorts of practices are declining. I just wish that this government would start to understand what women in this country want, that they would tune in to rural and regional Australia, that they would go out amongst the real people in real communities and understand that there is nothing more distressing for a woman than to have to go and attend a hospital for a birth when perhaps her first experience of a hospital was less than optimal or if she wishes to be surrounded by a supportive partner and others at the time of birth in a home environment. This is a very fundamental issue and I feel that women and midwives have been very much let down by this government. I am surprised; it should have known better.

A lot of lip-service is paid by the Labor Party to choice in the area of women’s reproductive health but, in this particular circumstance, women have been insulted, their rights have been trampled on, their choice has been severely limited and professional women who practise as midwives have been treated like backyarders with no cares and no skills to pass on to women as they come through one of the most important times of any woman’s life, and that is giving birth to a healthy baby. I have been told by my midwives and by a number of their clients who have had both a hospital and a homebirth experience that, if there is some trauma or distress during the experience of giving birth, in comparing their experience of professional care at a hospital to that of professional care at home, they had a much more supportive experience in the homebirthing situation when there was extra care needed or when some unforeseen difficulty arose. Women in the child-birthing situation felt that they had greater support than the women left in hospitals, often with very little attention or chance to understand what was going on.

This bill is a disappointment. I certainly believe that we are going to see a big change occur in the future in midwives’ rights in the area of insurance. It will be a shame if we have to wait until the next election, when the coalition is restored to government, for those changes to be made. I urge this government to make those changes.