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Wednesday, 23 October 2002
Page: 5739


Senator RIDGEWAY (3:55 PM) —I move:

That in the opinion of the Senate the following is a matter of urgency:

The need for the Federal Government to act to include midwives in the medical insurance rescue package, as by next week all agencies supplying contract and casual midwives—around one quarter of all working midwives—will be unable to obtain professional indemnity insurance cover precipitating an immediate crisis in the safe birthing of babies in both public and private hospitals.

I move this urgency motion because of a dramatic worsening in the professional indemnity insurance situation as it applies to midwives. We are now approaching a near-disaster situation in birthing and maternity care within Australian hospitals and birth centres. It is a developing disaster of which the government has been well aware for some time. It is also not the first time I have raised this matter in the chamber. I raised it as recently as yesterday—last evening in relation to the Senate Economics References Committee report that had been tabled—and in the last fortnight's sitting as well as on a number of other occasions.

When the recent insurance crisis hit, the federal government was willing to assist doctors and specialists not only through the financial assistance that has been afforded to failed insurer United Medical Protection but also as a result of the recommendations of the first report on the law of negligence—the Ipp review. With UMP, the government has offered millions of dollars in support of an insurance company that operated with opportunistic business practices that essentially led to its inability to be `an ongoing concern'. Yet, in this particular case, the government rightly recognised that this was necessary to ensure that doctors were able to continue to practise. At the same time, around 200 independent midwives who were unable to obtain professional indemnity insurance were seeking a relatively small amount of money, which was not forthcoming from the government. Midwives were also not initially invited to participate in the Medical and Professional Indemnity Working Party that was established by the Commonwealth government. That particular situation affected not only independent midwives but also around 500 future midwives who are and will be discouraged from entering the field by being unable to undertake clinical placements as a part of their studies.

Today I come here with this urgency motion as this situation has since escalated. By the end of tomorrow, one of the largest agencies providing contract and casual midwives will have no professional indemnity cover. It will no longer be able to provide midwives to public and private hospitals. Other such agencies have already closed the books on midwives. By early next week, most agencies providing any other contract and casual midwives will have no professional indemnity cover. To put this into context, the crisis in professional indemnity insurance now means that approximately 3,000 contract and casual midwives—that is, 25 per cent of all working midwives in Australia—will not be able to work due to the lack of insurance cover. These 3,000 contract and casual midwives are an essential part of the operations of birthing in public and private hospitals, covering daily roster shortages.

In Australia there are currently around 12,000 midwives, who attend 98 per cent of the 250,000 births in Australian hospitals and birth centres. They are the ones that provide the constant care and commitment to women before, during and after childbirth while doctors, obstetricians and others attend the birth only when it is necessary. Based on recent figures, this dramatic removal of 3,000 midwives from the health system in the work force globally is exacerbated by the insurance crisis. I ask senators to contemplate the situation where you or your wife or your partner or daughter arrive at a hospital or birthing centre next Monday in an advanced stage of labour, only to be told, `Sorry, can you come back another day? We have no midwives available.' You do not need me to tell you that the birth of a baby is not an elective surgery issue. When independent midwives and midwifery students lost their insurance coverage, the government ignored their plight. That affected 200 midwives and around 500 students enrolled in universities across the country. It appears that in this situation the government is once again prepared to ignore midwives by not responding to the plight of the 3,000 midwives that are now subject to their own crisis. Yet had this week's legislation program continued as planned, as the government would have wanted, we would have been voting on the government's bill to prop up UMP to the tune of around $500 million.

We have to ask the question: where is the government when it comes to assisting midwives, those who are most responsible for the safe birthing of our babies and who support our women and our babies into the future? Having recently had a birth in my own family, I know the value of midwives. We did not see much of our obstetrician, but we certainly saw the bill when it arrived in the mail. In order to ensure that senators are aware of the contribution of midwives, some crucial information needs to be provided. Firstly, the World Health Organisation says:

Midwives are the most appropriate and cost-effective care provider for normal pregnancies and normal birth, including risk assessment and the recognition of complications.

In addition, midwives provide continuous care to women from the early stages of pregnancy until around four to six weeks after the birth of the child—the kind of care that is not readily available from any doctor or obstetrician. Midwives also make good economic sense, cutting hospital and health care costs. The recently launched national maternity action plan stated:

Normal birth is more likely to be achieved when a woman has access to `continuity of carer' or `continuity of care' from a midwife who is responsible for her care throughout pregnancy, labour and birth, and the postnatal period ... The `continuity of carer' model of care has been proven to reduce the use of obstetric interventions in labour and birth, including the need for pharmacological pain relief, inductions, augmentations, instrumental deliveries, episiotomies and caesarean sections.

But all of this sounds very hollow when the agency representing these essential health care workers cannot find professional indemnity insurance, full stop. This is not a case of insurance premiums being too high; this is about blanket unavailability—the insurance is simply not available. One of the agencies involved described to me how they have `trawled the world' looking for an underwriter but have been unable to find anyone who will accept the risk. That agency's insurance cover expires tomorrow.

This morning, I heard the Prime Minister generously extending until the end of next year the insurance guarantee for doctors, and during question time Senator Coonan made her own announcement. This is a big deal, and we should provide certainty for doctors and those in high-risk specialties such as obstetrics. I want to commend the government for responding in the way that they have but, let us be quite clear, the Prime Minister's rescue package is assistance for doctors facing unaffordable premiums. I remind the government that the professional indemnity crisis facing independent midwives, contract and casual midwives and students of midwifery is not one of soaring or unaffordable premiums but one of getting any cover, full stop.

It seems to me that the government was quick to offer short-term insurance—and will continue to do so on a three-monthly basis— to the aviation industry while they were unable to obtain war or terrorism insurance. If the government can help there, then why can't they help in the case of midwives? This is a crisis of unavailability of cover, this is a crisis which has been building since July last year and this is a crisis of which this government has been too well aware. I now ask the government to take up the message in this urgency motion and put midwives in the insurance picture by extending to the 3,000 midwives who are likely to be out of work next week the rescue package announced by the PM this morning. I commend this motion to the Senate.