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Tuesday, 8 September 2009
Page: 8950


Mrs MIRABELLA (7:20 PM) —I rise to speak on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills, which have caused hundreds and thousands of women to come to Canberra this week with their families in tow to protest and to have their voices heard. Admittedly, these women form a very small minority of women, but it was quite heartening to see their determination and their strong belief in the rightness of what they were doing. In our great democracy too often people accept government decisions and bureaucratic decisions and say of the state or a department: ‘They’re too big for us to fight. We know they’re wrong, we know they’re ignorant, we know they’re prejudiced and we know they haven’t got all the facts, but it’s all too hard.’ I find that very frustrating as someone who believes in the importance of engaging everyday Australians in decision making and not just leaving it to politicians, powerful interest groups and lobby groups. It is quite sad that this attitude of helplessness and apathy often pops up right across the nation when we discuss controversial issues.

But on this occasion, in relation to what would have been a severe limitation, if not a de facto banning, of homebirths in Australia, we did not see that: we saw something else. We saw something that was very encouraging, something that was very uplifting. We saw the determined spirit of so many women around Australia, from every corner—many from rural and regional Australia, including 80 from north-east Victoria, from my part of the world. We saw them come to stand as one and to have their voices heard. I think it surprised a lot of people. The publicity they have managed to generate for such a small group of women stands as a testament to their determination, their organisation and their intelligence. I am sure it surprised a lot of people around the country and it surprised the government.

I want to mention specifically my local support group, the North-East Victoria Homebirth Support Group, who came to see me with a local midwife, Wendy Buckland, and we discussed their concerns. They told me about their support network and they told me about some of their experiences. But what was critical was that here were these women, local women—you could not distinguish them from other women in the street—who were quite distressed but were determined to do something about it. They wanted not only to retain the choice that they had but also to ensure that that choice, regarding where woman would give birth in north-east Victoria and indeed right around the country, was maintained for the foreseeable future.

We have seen the hospital systems around the country collapse and we have heard the scandalous stories of what happens in the hospital system, particularly to some pregnant women. We heard the promise made by the then opposition leader at the 2007 federal election, when he promised to fix hospitals and health by June 2009 or he would seek a mandate to take hospitals over. That deadline has come and gone. Hospitals are not fixed and we see the same problems perpetuated but no solution to fix them. We see all of this and we see medical resources taken away in many parts of rural and regional Australia.

I will give one small example from my part of the world, in north-east Victoria. Under the government’s new remoteness area classification scheme, many parts of my electorate are going to be disadvantaged in trying to attract GPs to practise in towns that will be classified under RA2 as ‘inner regional’ areas—towns such as Myrtleford, Rutherglen, Euroa, Violet Town, Nagambie, Yackandandah, Beechworth and Chiltern. These towns are going to be forced to compete with medical clinics in larger areas for medical experts and for GPs. At a time when the public hospital system continues its decline and continues to come up with scandalous stories and when the government are changing the rural and remote index classification, they are trying also to severely limit homebirth—in fact, to outlaw it. That is what they should have said from the outset. They should have been honest in saying, ‘Well, we believe this homebirth thing isn’t on; we don’t like it, so we’ll ban it,’ instead of using the backdoor way of this new legislation.

At this time it is even more important to give women, particularly in rural, regional and remote areas but also in the cities, increased choices about their health care and increased choices about how they are going to give birth. The government introduced this legislation to provide some carrots—to provide MBS and PBS access for nurse practitioners and midwives. We saw the indemnity insurance provisions that, up until last Friday, were causing particular consternation. The provisions did not cover midwives providing birthing services outside a clinical setting. That would really take away the choice of many women to employ an independent midwife, because it would effectively make it illegal for midwives to provide homebirthing services, as the National Registration and Accreditation Scheme was going to make indemnity insurance a mandatory requirement of registration from 1 July next year. Midwives without registration would have faced a maximum penalty of $30,000, and we saw many anxious mothers and mothers-to-be. Currently, in many parts of Australia, women who do have a homebirth contract privately with midwives without indemnity insurance. Here we had the big nanny state moving in and saying: ‘We don’t think you’re smart enough to make that decision. We don’t think you’re smart enough to make the choice about homebirth and to come to an arrangement with your midwife.’

At the 11th hour last Friday, in a joint communique from the Australian health ministers, we saw what appeared to be a two-year breathing space from this exclusion of midwives. What the Minister for Health and Ageing has tried to do, really, is to buy some time. It was all too hard: this small group of women who she thought would not make much of a noise, who would not cause too much of a problem. She thought, ‘Maybe if we provide a two-year exemption for them, up until 2012, from holding indemnity insurance then maybe we’ll be able to see it through the next election without too many hassles.’ I am sure the Prime Minister knocked on her door and said: ‘Minister, this is all too much. I don’t need this problem. Fix it.’ In the fashion of this government she is trying for a very short-term fix. The argument has been ‘Let’s maintain the status quo for some time’ but we really do need to ask questions. Does it really maintain the status quo or does it actually introduce additional restrictions—that is, we will not have a situation that maintains the status quo up until June 2012 but additional hurdles will be introduced for some women around the country? These matters do need to be investigated. Part of the requirements to access the exemption includes, and I quote from one of the dot points in the communique:

Participating in a quality and safety framework which will be developed after consultation led by Victoria through the finalisation of the registration and accreditation process.

But within the quality and safety framework there needs to be provision for a woman to make an informed choice so that she can still access a midwife if she falls, for some reason, outside the framework. We know this framework does not currently exist, so if there is a framework imposing certain conditions, by definition it introduces new restrictions on the practice of homebirths with the use of midwives.

This would be consistent with medical practice, which allows patients to exercise their right to refuse treatment. I think it is very important for the minister and the government to know that homebirth mothers and midwives around the country have not been fooled by these provisions in the joint communique. They will watch very closely to see that the framework and guidelines that come out of it do not actually limit the genuine and real choice that mothers and midwives have.

There are some questions as well as to whether these provisions will actually apply to all jurisdictions. We do not know what the government means by some of the wording in the communique and whether some jurisdictions are excluded from having these provisions and if the so-called quality and safety framework applies to them. That really does need to be examined and looked at.

I have spent a lot of time over the last few weeks and months speaking to many concerned women, and it is interesting that there are a lot of women who are not homebirth mothers, who have not had that experience, but who feel so passionately and strongly about supporting the choice of women. We hear so much from the other side of politics, on convenient occasions, about the choice for women, but where is the Minister for the Status of Women? If I have missed something, could someone on the other side please correct me? She has probably been silent because she is embarrassed by the mismanagement and the arrogance with which the Minister for Health and Ageing has conducted this debate. The government needs to make sure that consumers, who have really been left out of the equation to date and ignored, do get included—they are critical to this debate. As we have seen this week, they will not let the government or anyone forget that they are important and that they do matter.

In order that the choices for women—the intimate and personal decision that they make in consultation with their families—do not just get swept under the table and, effectively, banned, we do need to take some steps to look at these issues in the intervening period over the next two years. Although the government’s recent changes allow for a temporary reprieve, we do need to look at what more we can do. The first step would be for the government to release the actuarial modelling associated with the indemnity insurance scheme. Why have we asked for this? Because it would allow for informed consideration and actual debate—not just silence and backroom deals, but actual debate about the feasibility of including midwives providing homebirth services in the category of eligible midwives for the purposes of indemnity insurance. We know that is what the vast majority of women supporting homebirths and their midwives want. This is also consistent with the recommendations of the minority report of the Senate committee. I do not know why it has fallen on deaf ears; perhaps people power this week will make the minister listen to this particular request. To date we have only seen a very limited explanation as to why the feasibility of extending indemnity insurance to midwives providing homebirthing services has not been considered. The coalition continues to call for the release of this information.

We also call for a review into the provision of medical indemnity insurance for these midwives to be tabled in the parliament on or before 1 June 2012, prior to the conclusion of the proposed transition period under the draft national registration and accreditation legislation. We believe these measures are essential and, despite many opportunities to actually engage on this issue, the minister has failed to be a true minister of the Crown and take leadership on this issue. This has been dragging on for months and we are looking to take positive steps. That is why I will move the amendment circulated in my name, in an attempt to progress this issue—not to sweep it under the carpet but to ensure that we continue to investigate, to use the facts, to use the research and to use the information to see what we can do to facilitate real choice for women.

As shadow minister for, amongst other things, women, it gave me great pleasure this week to see the exercise of ‘woman power’. I know that the government and I can count on one thing: these women, who are well informed and well equipped, will not cease this campaign—and nor should they, because as consumers they have been left out of the equation and as homebirth mothers they have been ignored and pushed aside. But they have shown the government and the Australian people that it matters not that you are part of a small minority; if you believe in something strongly enough, and you have got the facts and figures to back you up, you can succeed. I believe they can, and I urge the government to support the amendment that has been circulated in my name. I move:

That all words after ‘That’ be omitted with a view to substituting the following words:

‘whilst not declining to give the bill a second reading, the House:

(1)   acknowledges that the bill does not:

(a)   facilitate a full and informed debate by requiring the minister to table all actuarial modelling relating to the extension of Commonwealth medical indemnity insurance to midwives providing birthing services outside of a clinical setting;

(b)   further facilitate a full and informed debate by requiring a review into the provision of medical indemnity insurance to midwives providing birthing services outside of a clinical setting, with the review being tabled in parliament on or before 1 June 2012;

(c)   have in its objects the goal of not restricting the rights of women to choose home birth as an option provided the wellbeing of the mother and child are not put at risk; and

(2)   calls on the government to make such amendments to the bill as would rectify these flaws.’


The DEPUTY SPEAKER (Hon. BC Scott)—Is the amendment seconded?


Mr Pearce —I second the amendment.