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Tuesday, 8 September 2009
Page: 8943


Mr ANDREWS (6:49 PM) —There is no more deeply personal experience for most women than giving birth to a child. For most men who participate in or witness a birth, especially where it involves their child and their wife, there is no emotional experience that can replicate that event. What we are discussing with the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related legislation is something that goes to the very meaning of life. It goes to our sense of being. It goes to the values of this government.

These bills extend Commonwealth subsidised indemnity insurance to eligible midwives. According to the bills an eligible midwife is a person who:

(a)   is licensed, registered or authorised to practise midwifery by … the Commonwealth, a State or a Territory;

(b)   meets such other requirements … as are specified in the Rules …; and

(c)   is not included in a class of person specified in the Rules for the purposes of this paragraph.

From the minister’s second reading speech we learnt that Commonwealth supported professional indemnity cover will not respond to claims relating to homebirths. The impact of the bills as presented to this parliament, which are in response to recommendations of the maternity services review, is that indemnity insurance provisions will not cover midwives providing birthing services outside of a clinical setting. The National Registration and Accreditation Scheme will make indemnity insurance a mandatory requirement for registration as of 1 July 2010. Therefore, under the terms of the bill as introduced into this parliament, it will be effectively illegal for independent midwives to provide homebirthing services from this date. Indeed, individuals who practise as midwifes without registration face a maximum penalty of $30,000 in accordance with the Health Practitioner Regulation National Law 2009 exposure draft.

The response to these proposals was an outcry not only from midwives but from many members of the community. Most people do not choose to have a childbirth at home. Most choose to use the services of the major hospitals and allied clinics throughout Australia. Indeed, it is a statistic which, perhaps, we ought not to be so proud of that we have one of the highest rates of caesarean births in the world, far above what world health authorities regard as an acceptable level. But the reality, nonetheless, is that most women choose to make use of the services of major hospitals. Increasingly, some have chosen birthing units which are associated with those hospitals, which are a kind of halfway house between the traditional clinical birth and a homebirth experience; indeed, my wife and I did that for our last child. However, many people still believe that a parent—a mother in particular—ought to have the right, if she chooses and the family chooses, to have a birth at home. After all, this is not an uncommon experience in either human history or, indeed, the world of the present time.

Indeed, there are some studies from the World Health Organisation and others that suggest that there is no greater danger, in normal circumstances, for a birth at home than there would be for a birth within a hospital setting. A recent study of over 500,000 births showed no difference in the mortality rate for the baby and mother between home and hospitals. That was the 2009 study by de Jonge. Also, research by the World Health Organisation found that a homebirth is as safe as a hospital birth for healthy women having their first baby and that, for women having subsequent children, the result of a homebirth is significantly better than the result of a hospital birth. That was the report by Wiegers et al in 1996.

The result of this outcry and the protests we have had—I have had women from my electorate come to see me about this matter, as I suspect most members of the House have—is that last Friday the government partially backed down on this controversial provision when the Minister for Health and Ageing announced a two-year delay in regulations that require private midwives to have indemnity insurance for homebirths. Of course, private insurers will not cover homebirths and the government will not subsidise indemnity insurance for homebirth midwives. Midwives must tell their clients that they are not insured and must get informed consent from pregnant women who want a homebirth.

What troubles me about this partial backdown is that it is not clear what the government’s intention is in putting in place this two-year delay. Is it for the purpose of ascertaining whether or not indemnity insurance can be provided—I understand the reason it is not provided is not the risk factor or the risk ratio but that there is not a large enough cohort of midwives in this situation for insurers to provide that insurance—or is it because the government actually believes, as would have been the effect of this legislation, that homebirths should be banned? If it is the latter then the government should say clearly that that is the case. This should not be a backdoor method of banning homebirths in Australia.

The reason I retain a degree of scepticism about the government’s motives is that there is a track record in relation to some health matters. For example, we had the alcopops tax introduced. The reason given was that this was a health measure, but when looked at in some detail it became clear that in fact it was a tax measure. Therefore members of the community have a right to be suspicious about the government’s motives in relation to this matter. If it is the government’s argument that there should not be homebirths in Australia, it would be better if it came out and made the case for that situation.

The two-year delay has been put in place. I would hope that during this two-year period we have proper evidence provided to us—that is, where homebirths are taking place there should be proper reports of those circumstances, including any complications which arise. I understand that we are not just dealing with the mother. Many members have spoken about the woman’s rights, but the reality is that we are also dealing with the life of the child who is being born. That therefore leads one to having to balance in consideration the circumstances of both the mother and the child. If the evidence is overwhelming that this is a much more unsafe circumstance for the birth of a child that cannot be ameliorated by other measures such as the proximity of a hospital or other more intense clinical services, that can lead to a particular conclusion. But if the evidence—I have cited some which is available to me from global studies—is that there is no greater risk factor for homebirths than there is for births that occur within a hospital then there would seem to me to be no reason for what appears to be, on the face of it, discrimination against homebirths. That is evidence which I believe we as the opposition—and, I am sure, other members and senators—will be interested in as to what is produced over the next two years, after which this matter is ultimately coming back to the parliament. As I said, the situation in relation to hospitals is not entirely ideal either. I am not sure that we should be satisfied with the very high levels of caesarean births which occur in this country, but I have not seen any great examination of why that is occurring. There could be many factors in play with that.

But that is not the purpose of my contribution tonight. It is simply to say that I understand that, yes, you have to balance the situation of both mother and child, but at least on the evidence available to me it would seem that it is not a more unsafe practice in normal circumstances to have a homebirth. And, if the reality is that the government is providing a subsidy for indemnity insurance to other medical and health professionals, it does at least seem on the surface that there is some discrimination being practised or that some discrimination was about to be practised towards those midwives who were assisting those mothers who chose to have a birth at home.

I will conclude my observations on this note: the ball is in the government’s court over the next two years to produce that evidence and to come forward with a proper rationale based on evidence. This is clearly an area where policy should be based on evidence, not based on the prejudices of anyone who happens to have a particular view about this matter.