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Tuesday, 8 September 2009
Page: 8938


Mr RANDALL (6:26 PM) —This evening I welcome the chance to make a contribution to this cognate debate on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009. With thousands of Australian women, I welcome the Minister for Health and Ageing’s most recent backflip, which is that the government will offer a two-year reprieve—or, as the member for Dunkley said, a stay of execution—for midwives to attend homebirths. This was clearly the most controversial aspect of this legislation and, while it is not yet fully resolved, it is yet another embarrassing backflip for the Rudd Labor government.

The minister is all over the place on health decisions. Recently I spoke about the cuts to chemotherapy medication, following representations from several constituents—some seriously ill. Thankfully, the minister realised the error of her ways and backflipped on these plans as well. This government has had an array of shamefaced backdowns and has left serious uncertainty over a number of important issues—for example, private health, IVF treatment, youth allowance, funding for the National Academy of Music and cataract surgery. How can we forget the Deputy Prime Minister’s involvement in axing IVF funding after tabling a petition in 2005 calling for no changes to Medicare funding of IVF treatments. Ms Gillard said it is a cruel thing to do to Australian women, particularly older Australian women, whose only hope of falling pregnant is through the IVF process. But what did she do when she became a minister? Nothing.

The government’s hypocrisy is blatant and its approach to health is sickly. The shambolic decision making is the result of a government that is focused on re-election and focus group feedback rather than on the interests of the Australian public. If it were not for the public outcry, the 2,000-strong rally yesterday with women shouting ‘home birth rocks’ and the pressure from the coalition, the government would not be having a change of heart.

As we have heard, this legislation provides MBS and PBS access for nurse practitioners and midwives, which will commence on 1 November 2010, and Commonwealth subsidised indemnity insurance for midwives working in a ‘collaborative’ setting, to commence on 1 July 2010. These bills extend Commonwealth subsidised indemnity insurance to eligible midwives. It is the definition of eligibility that drew a strong public response. The indemnity insurance intention was not to cover midwives providing birthing services outside of a clinical setting, forcing homebirths underground and risking the health and wellbeing of mothers and babies. Coupled with the national registration and accreditation scheme to make indemnity insurance a mandatory requirement of registration, the unfortunate result made it effectively illegal for independent midwives to provide homebirthing services. Individuals who practised as midwives without registration could have faced a maximum penalty of $30,000.

The minister now appears to have adopted the position advocated by the coalition to maintain the status quo and allow midwives to continue to assist in homebirths. As I understand it, they will be exempt from holding indemnity insurance for the next two years, which will enable them to continue to assist in homebirths. While they can assist in homebirths, they will not be insured. I make this point: they will not be insured during that period, which is quite a problem. This is a step forward and it will allow for debate, costings and the examination over the next two years, but let us not forget that it should never have come to this in the first place.

Midwives and nurses are the cornerstone of health services. I am a proud father of two children and was present at the birth of my daughter and my son—I was not much help, by the way. The midwife in attendance did all the work. On a wet and rainy night, the obstetrician turned up almost after the first birth had occurred.


Mr John Cobb —Pretty normal.


Mr RANDALL —That is right. We paid a large fee to the obstetrician, but the midwife did all the work. I take my hat off to midwives. Parents put great thought, time and effort into finding a birthing plan that is right for them. That is my point: choice. My wife chose to go to a major hospital. Many in my electorate who have contacted me about this want a choice. We on this side believe in choice. We are not part of the herd mentality; we believe in the individual’s right to choose. The Rudd government wants us to take such a nanny-state direction that fundamental choices are being taken away.

What right does the government have to determine how you give birth, one of the most personal and meaningful experiences in a woman’s life? I certainly do not profess to be an expert on the medical merits of birthing choices, but there have been plenty of experts who have entered the debate. The Senate Community Affairs Committee took over 2,000 submissions. The 2008 Review of homebirths in Western Australia commissioned by the Western Australia Department of Health looked into access and outcomes for homebirths. The report found that developing systems to support safe and satisfying systems of care that provide child-bearing women with diversity options are essential, and midwives are critical to this process.

Many women and families support homebirth because it is a safe, low-risk option for most women. They believe it offers continuity of care and caters for women who want to birth in the comfort of their own surroundings. Homebirths are a choice, I must say, for a relative few. Studies have shown that less than one per cent of Australian women have homebirths. So we are not talking about a huge cost here, particularly for a government that seems to want to throw money at everything at the moment. This has been a surprising potential cut. In fact, homebirths actually save money because it means that there is less pressure on public hospital systems.

Western Australia sees about 200 planned homebirths a year which are generally managed by the Community Midwifery program or by independent midwives. The Community Midwifery program offers a great service but does not extend beyond the Perth metropolitan area. This means that most women in my electorate of Canning rely on independent midwives because Canning has half its population in the metropolitan area and half in the outer metropolitan area. In terms of land mass, something like two-thirds of the electorate is outside the metropolitan area.

As an aside, I would like to take this opportunity to speak about midwifery training in my electorate of Canning. We are extremely lucky to have the Peel Campus of Murdoch University in Mandurah which specialises in nursing. The school offers a Bachelor of Nursing, which has been highly successful. It also offers masters of midwifery and advanced nursing. The best outcomes are that many of these locally trained nurses and midwives stay in the local area, working in hospitals in the Peel region and south-west corridor—and that was its intention.

Industry groups have been highly critical of the government’s initial attack on midwives. Homebirth Australia was outraged by the decision that would have seen homebirths with a privately practising midwife essentially made illegal. The organisation has acknowledged that Minister Roxon’s backflip is a step in the right direction but the failure to provide indemnity insurance remains highly unacceptable. The Australian Medical Association, the AMA, the peak body, said:

Actions by the government which favour one particular new model of care over another will generally not be in the interests patients, will restrict real choice and will be inequitable.

The Australian Private Midwives Association’s Liz Wilkes considered the decision ‘highly disappointing’ and said:

It looks like the voices of more than 2,000 women speaking out on fundamental women’s rights have been ignored and given the sheer magnitude of the evidence put forward and the results the committee has come up with, it looks like we are getting to the end of the line when it comes to options.

Ms Wilkes believes the government’s change of heart is merely a bandaid solution. Women and their partners do not make homebirth decisions lightly. Great consideration goes into this important decision and people make that on the basis of informed advice and knowledge.

Many Canning constituents have approached me, appalled by the government’s attempt to take away their choice. These women have either had a homebirth or support the option of homebirth. They support the choice. One said to me:

It is unacceptable that women are unable to choose the care of a registered midwife to give birth at home. I don’t understand how the Government would want to take away a safe option that saved them money in the long term as we are not using the hospital system.

You might have noticed in the media today there was quite a contingent of women from Western Australia at that rally yesterday. I can assure you they travelled a long way and at great expense to come to Canberra on a bleak, cold day. A Mount Nasura woman said to me:

If midwives in private practice are not assisted, they will be prevented from registering. If they practise unregistered they will face a jail term. If national registration proceeds as planned, women choosing homebirth will be unable to access a registered midwife and essentially the practise will go underground. It is not acceptable that women are unable to choose the care of a registered midwife to give birth at home. Homebirth is a nationally funded option in the United Kingdom, Canada, New Zealand and the Netherlands. I ask that you support a women’s right to choose where and with whom she gives birth.

Similarly, Mrs Cole from my electorate has said to me:

It is unacceptance to me and all women that any government has the right to control our bodies and take away the choice of where and with whom we give birth.

I conclude by saying that the coalition strongly believes that this is an issue which fundamentally is about choice. As I have already said, we are a party that believes in choice, whether it be in health, education or many other life areas. We do not believe in the herd mentality that comes from the other side. It should be for parents, in consultation with health and medical professionals, to make the very important and personal decision of the model of care for childbirth. We look forward to the health minister releasing the government’s costings, complete actuarial modelling and policy detail—and hope that this stay of proceedings is not just that; we hope that there is an eventual resolution to both the insurance and choice issues. I thank the House.