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Monday, 15 March 2010
Page: 1838

Senator ADAMS (8:48 PM) —I too rise this evening to speak on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills. Being the only trained nurse and midwife within this parliament, I feel that perhaps I do have a little expertise. Senator Moore, I and the other members of the Senate Community Affairs Legislation Committee also worked very hard with the people who came before us during two inquiries. The first inquiry was on 6 August 2009 and we had 1,958 submissions. Our second inquiry was on 17 December 2009 and we had 933 submissions. I think this indicates how very strongly the general public feel about this issue.

Might I say at the outset that I am very pleased that these bills have come forward, because 1 July was coming up very quickly. I feel very sorry for those women who will be having home births or have private midwives and will then be going, under the care of the private midwife, into a hospital to have their baby. This has been a terrible time for them. They have been put through an enormous amount of pressure. I can assure you, having had two children, that being pregnant is pretty hard—but, by gee, imagine that you are pregnant and you are not sure whether or not the person who has taken you through your pregnancy, who has been looking after you and supporting you, will be beside you after 1 July.

As I said, having sat through numerous deliveries in the time that I was working as a midwife, I can say it really is an exciting time. The fact is that as a midwife you tend to be with the patient, a complete stranger, in your hands, with her husband or her partner, and you go right through every contraction, through everything they are feeling—the angst, the anxiety. You are there to support them if things do not go right but also to congratulate them on having the birth of a normal, happy child. It is such a terrific area of nursing. Before I became a midwife I was working in operating theatres. You get to the stage—although this sounds very bad—where you have lists and lists of different types of operations that you are going to do; and, unfortunately, when your next-door neighbour comes down and goes through the theatre you do not realise who it is. I decided I had better go back to midwifery. I really do have a great passion for it.

I am not sure whether I heard Senator Sterle say that the coalition had not supported nurse practitioners, but I can assure you—going back probably 11 years in Western Australia, when we had the first nurse practitioners—just how supportive coalition and Liberal governments have been towards the nurse practitioner. Originally their role was to be to go to remote areas of Western Australia, and then later into remote areas in the rest of Australia. But, unfortunately, a number of the people who became qualified, having done their nursing, gained considerable experience and then gone on and done a masters degree—they are very well educated and well trained—decided they would rather work in the city, in the emergency departments and those areas. So I really would encourage anyone who is a nurse practitioner, if they could possibly go out and help in the rural areas, to do so. It would be a really great thing for rural areas.

We used to have what we called nursing post sisters. I did a lot of relieving in these areas as one. I think that a nurse practitioner could fill that role very adequately for the community. Unfortunately, as we are all aware, trying to attract GPs into rural areas is very difficult and trying to attract a GP who has qualifications in obstetrics is even harder because these people like to stay in the city and a number are not taking up the work because of the problems of litigation and the cost of their indemnity insurance.

We are looking at the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009. For eligible nurse practitioners and midwives, the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill will provide the right to request certain diagnostic imaging and pathology services for which a Medicare benefit may be paid; the right to prescribe certain medicines under the Pharmaceutical Benefits Scheme, known as the PBS; and new Medicare items and referrals under the Medicare Benefits Schedule, known as the MBS, for midwives and nurse practitioners working in collaborative arrangements with doctors.

I will speak later about the collaborative arrangements, which have been quite a problem, but I will say that the passage of these bills has been very difficult. At the supplementary budget estimates hearings in October it was very, very difficult to find out from the Department of Health and Ageing what the definitions of eligible midwife and nurse practitioner were. Unfortunately, the legislation had been put through but the regulations had not been prepared. Even some of the most experienced department officers could not answer the questions I asked. That made me very dubious about what was happening with these bills. It was one of the reasons that later, when we did get the completed legislation, we pushed very hard to have another hearing, as did members of the public. Senator Macdonald has spoken about the number of people that spoke to him about whether they could have a choice and have a home birth or go with their midwife and be able to go to a hospital if things did not quite work out.

As you can imagine, as the only midwife in the parliament, I have received a large number of emails and many people have come to see me. I felt privileged that those people chose to come and talk to me about their concerns. I was able to talk to them on a first-hand basis about their problems and how they were feeling. I do hope that the coalition will not be opposing these bills, so that on 1 July those mums-to-be and the midwives looking after them will be feeling a lot happier and more confident about their situation.

I have been very frustrated with all that has gone on since the legislation came out. I think that the members of the Senate Standing Committee on Community Affairs should be congratulated on the work they have done on this legislation. I am not satisfied with the end result, but I think it is a great start. Nurse practitioners will now have prescribing rights and be able to do a lot more than they are doing and our midwives are going to have the opportunity to continue practising rather than being fined if they continued to practise, as was the case with the first lot of legislation. That meant that probably 200 of the most experienced midwives in Australia were going to be penalised because the government had not looked at its national registration legislation, which conflicted completely with the fact that an eligible midwife had to have indemnity insurance. Unfortunately, those who work as homebirth midwives are ineligible to have insurance because no-one will insure them. That was a real worry and I would hate to have seen that happen, particularly as I know a number of these midwives. Also, it was not going to give women a choice.

As a midwife, I look at the safety of the mother and the baby. When the coalition senators submitted their additional comments to the inquiry we held in December we said we wanted some sort of arrangement where a woman who is having a baby has to be booked into a hospital and her midwife work with the local GP. Then if something were to go wrong the woman would be able to have a safe delivery in the hospital into which she had been booked. I believe that this is the safest way. Some of the women were saying they had had children before by homebirth with a midwife and everything had gone well, and they were having another one and saying, ‘If my midwife can’t do anything for me I am going to have a free birth.’ I would hate to see that. It is the last thing we want: a woman at home labouring, probably with children and her partner there. If something were to go wrong it would be a dreadful thing for a child to be present to see that happen.

Most midwives have an effective relationship with the doctor anyway. I just think back to my own days in the profession. The doctors knew what we were capable of. I was trained in New Zealand and we did most of the deliveries within the hospital and the GP came in later. They very rarely were there to do the delivery because they considered that the midwives were well practised in it and had been with the woman through her labour. The GPs did not want to interfere except to be there to congratulate the mother and her partner on the birth of their child.

Being a midwife, there are a lot of things I could say, and I will support these midwives so long as I am in this parliament. They play such a terrific role. During the inquiry there were issues raised by the AMA and the doctors, but I think there are terrific partnerships between health professionals. Evidence was given by the AMA, but, when members of national bodies give evidence at these inquiries, they tend to have moved away from or forgotten about their practical experience years ago—though I will not say that about the current president of the AMA, because he is an obstetrician and gynaecologist. It was hard because, obviously, the nurse practitioners and midwives are to be given rights that are normally restricted to the medical fraternity. But I think that as a team they can work together for the good of the community. With low-risk homebirths and the midwife’s collaboration with the doctor, hopefully it will all go very well.

This word ‘collaboration’ really has caused some problems. The doctors associations all wanted a signed agreement with midwives. In some rural hospitals only one doctor is on duty, but how many doctors perform obstetrics in the larger hospitals? Some babies come on time, but not many do and they come at all hours of the day and night and other people are on call. These collaborative arrangements meant that the midwife was going to have to have an arrangement with the medical superintendent or whoever was in charge of the other professionals who perform obstetrics, which would create a complication. The midwives were pushing for what they called a collaborative practice. Senator Siewert spoke about this. Collaborative practice is exactly what is happening now. All these hospitals have guidelines. The midwives are working under these guidelines and are fully aware of their rights and responsibilities, as are their patients. Unfortunately, this time around it was not to be. There will be a collaborative agreement, but I still feel that this legislation has moved mountains as far as nurse practitioners and midwives are concerned. I believe that it will bring together a much more cohesive team—and I do not want to omit the other allied health practitioners, who often are involved with the midwives in helping their patients.

It really is a step forward, but I do have a few reservations about the way that things went on. It did get a bit nasty, but as a committee we are quite used to that. We dealt with it very well and I am certainly proud to have been a member of the community affairs committee when it received this evidence and conducted the inquiries. The inquiries were very rushed, with only a day for each. With such a terrific number of submissions, we were able to accommodate a number of witnesses by having four or five community people there together giving evidence with the support of others rather than sitting alone at the witness table. We were able to achieve that, but, if the legislation had been a lot clearer, the regulations had been prepared and there had been a lot more consultation by the minister with the nurses, nurse practitioners, midwives and doctors, the Senate probably would have passed this suite of bills a lot sooner.

At least parents are going to be given a choice as to what happens. The midwives have guidelines. They know where they are going and what the consequences are. I hope that after these bills are passed, if certain issues have to be amended later, that will occur. I believe the committee did a great job. I congratulate the chair on the way in which she conducted these inquiries. As you can imagine, with the number of people who put submissions forward, there was a lot of disappointment because they could not all come before us. I will be supporting the legislation.