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Wednesday, 23 October 2002
Page: 5742


Senator McLUCAS (4:13 PM) —I also rise today to support the urgency motion moved by Senator Ridgeway. For the benefit of Hansard, I think it is important to read again the words of this motion. The matter of urgency is:

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.

The government must move to address the insurance crisis that midwives are facing and, in doing so, gain an understanding of the potential impact that the lack of action would have on women and families in this country. Having experienced childbirth myself, I know of the support that midwives can provide to a woman during that process. I was fortunate to be supported by a midwife during my delivery and also in prenatal and postnatal care. Midwives provide a service that obstetricians and gynaecologists just simply do not have the time to. They provide an enormous amount of support; they have the time. They are often women, although there are some men, and they have a greater empathy with an expectant mother. As an older potential parent—as I was before the birth of my child—with no family close to me, the relationship between me and my midwife was a very strong one. Especially as a person coming from a regional area, I relied on her very much for support.

There is a real crisis facing our community when over 3,000 contract and casual midwives cannot get professional indemnity insurance—that is about one-quarter of all working midwives in Australia. Whether you have your baby in a hospital or at home, a midwife assists in almost every birth that occurs in this nation. Approximately 250,000 births occur in Australia every year and the vast majority of those births take place in a hospital assisted by a midwife. These contract and casual midwives are an important part of birthing in Australia, with midwives assisting in rostering and daily shortages. The involvement of midwives in the birthing process provides a positive health benefit for our community that we cannot overlook. The benefits are of course to the mother and the child, as I have explained from my personal experience. A good relationship between an expectant mother and a midwife statistically leads to reduced intervention in the birthing process. It has also been shown that bonding between the mother and the child is improved if that process is a more comfortable one.

We all know how much strain the health system is under because of the government's attacks on public hospitals and the public health care system in general. The failure of the government to address the crisis facing midwifery is just another symptom of government mismanagement of health care in this country. Expectant mothers and their partners and families should not have to worry about whether or not our health care system can meet their basic needs. With the Americanisation of health care in this country, however, increasingly the quality of care you receive is based more on the size of your wallet than the need that you have. Whilst that is true, the actual reality that we are facing is the absolute unavailability of midwives. That, of course, will increase pressure on the obstetricians in the country. Senator Knowles suggested that the federal government had no role at all in supporting midwives in their need to obtain professional indemnity insurance. She said that there was nothing that we could do, nothing that the government could do. There was something the government could do when we had the crisis in the aviation industry late last year; there was something that we could do when Ansett collapsed. I am afraid that the reality is that the government is simply sitting on its hands.

There has been significant discussion recently about declining fertility rates in Australia and the need for government policy on balancing work and family. We have heard a lot from the Prime Minister about the need for this to occur. We have heard a lot of words but, unfortunately, we have seen very little policy. Providing quality services to mothers and their partners during and following the birth of their child is central to the debate about declining fertility rates. As I have said, midwives play an essential role in ensuring mothers receive the appropriate care and support that they need at that time. I suggest that women are more likely to want to have more children if their first birthing experience, and their prenatal and postnatal care during that time, is reasonable. You are certainly not going to come back happily if you have had a fairly difficult birth; you would have to think twice. I suggest that the crisis in midwifery could have an effect on women making choices about whether or not to have a second or third child. The issue is also about choice. Women should have the option to choose whether to have their baby in a hospital or at home. Women are increasingly wanting to give birth in a place of their choice, and that is often their home. They find that option suitable to their needs. Unfortunately, if midwives are not going to be able to gain professional indemnity insurance then that may not be able to occur.

The other concern that I have is for women in rural and remote areas. In the Senate Community Affairs References Committee inquiry into nursing, we were given very strong evidence about the lack of availability of midwives. In fact, we noted in our report, The patient profession: time for action, that there are shortages of registered midwives across every state in Australia. We all know that this is exacerbated in regional and rural areas, with impacts on the women who live in those areas. But the other area of my concern is the impact that it has on Indigenous women who want to take the option not to travel. Many Indigenous women who live in remote areas do have to travel a long way from their community in order to have their baby. In North Queensland, women have to leave their community six weeks before the expected delivery date of their child and travel in most cases to Cairns but often to Thursday Island or Mount Isa. Six weeks of separation from one's family is difficult.

There have been efforts by the state government in Queensland to encourage women who do not have a series of risks to deliver their children at home. This shortage of midwives will exacerbate that initiative enormously. If midwives cannot practise in rural and remote places, I would suggest that the opportunities for women to give birth in their communities will be almost zero. Indigenous women deserve choice; rural and regional women deserve choice. Women deserve to be able to choose where to have their child, whether it is in a hospital or at home. This crisis facing midwives will put enormous pressure on the ability of those women to actually make those choices.

The government has recognised today, in its statement about medical indemnity insurance, the important work that doctors and specialists, including obstetricians, do in providing health services to the community. It has extended its insurance protection to that sector. Unfortunately, the announcement today in no way goes to the issue of professional indemnity insurance for midwives. Maybe the Prime Minister just does not know or understand the crisis that faces midwives and women in our community, but he should have included them in his framework. Labor does recognise the crisis that midwives face. The press statement today from Stephen Smith, our shadow minister for health and ageing, says:

The medical indemnity insurance package announced today also fails to address the professional indemnity needs of health care professionals such as midwives who are also facing a crisis situation that may result in further withdrawal of services.

I commend the motion to the Senate.