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Monday, 15 September 2008
Page: 87


Senator PRATT (9:50 PM) —I rise to welcome the ‘Improving maternity services in Australia’ discussion paper launched by the Rudd government last week. The paper raises an issue of vital importance to the wellbeing of Australian families—the quality of maternity services. In the late 1990s, major reviews were undertaken into maternity services by the Senate Standing Committee on Community Affairs and the National Health and Medical Research Council. Despite the fact that these reviews highlighted the need for national leadership to drive reform, no comprehensive response to these reviews was forthcoming from the Howard government. Non-government organisations stepped in to fill the gap.

In 2002, the Maternity Coalition, a peak body representing the consumers of maternity services, produced its own National Maternity Action Plan. The plan highlighted the scientific evidence demonstrating that women and babies have very good outcomes from midwife-led care. It noted that the right to choose a midwife as a lead carer was available to women in many other OECD countries but is not available to all women in Australia and it called on governments to reform maternity services. State and territory governments responded, but the Howard government did not. While the Howard government sat on its hands, workforce issues and an overall trend towards the centralisation of specialised medical services exacerbated problems with provision of maternity services in regional areas.

In 2006, the National Rural Health Alliance sought to secure a higher place on the national policy agenda for rural and remote maternity services by producing its own policy document. This document estimated that up to 130 rural maternity services have closed in the last decade. Not surprisingly, given the history of Howard government inaction on this issue, the paper’s first recommendation called for national frameworks and strategies to promote rural and remote general practitioner and midwife practice. The work of the National Rural Health Alliance finally goaded the Howard government into taking some action. A consortium of the health professions involved in maternity services was funded to develop a guide to appropriate rural maternity services.

The work that has been undertaken by consumer groups and health professions to progress the reform of maternity services in Australia is to be commended; however, it is not the job of either consumers or professional associations to develop national frameworks for the implementation of major national health reform. That is the job of the Australian government. It has a role to balance the views and interests of all the stakeholders involved. In my own state of Western Australia, the development of a new policy framework for maternity services involved an extensive community consultation process. I was a member of the cross-party select committee into public obstetric services in WA, which reviewed models of care and the WA government’s maternity services reform process. The consultation processes got a big tick as it successfully began to bed down issues between stakeholders, including midwives, obstetricians GPs and consumer advocates. One of the objectives of the new policy framework for maternity services in WA is to:

increase the capacity for midwives to provide one-to-one care to women throughout pregnancy, labour and childbirth, facilitating greater individual support, and enabling continuity of carer.

The importance of this objective cannot be overstated. It is a response to the views of the women themselves in Western Australia and elsewhere that rate continuity of carer as critical to quality maternity services and support a move away from hospital based, medically focused models of care towards community based primary care services.

Like most good public policy this accords with commonsense. Of course, women would prefer that the person who provides them with their antenatal care also sees them through the birth of their child and cares for them in the first weeks after their baby is born. However, the number of women who have access to such care is severely limited. Women want carers they know and who know them to see them through this process—a process that is absolutely critical to the formation of strong and healthy families.

Increasing the capacity of midwives to provide one-to-one care is also a sensible response to workforce issues. Put simply, continuity of carer cannot be guaranteed unless we make full and flexible use of the skills of all the health professionals involved in the provision of maternity services. This includes GPs, obstetricians and midwives. There have never been enough obstetricians to enable obstetricians to offer continuity of care to public maternity patients—not even in metropolitan areas—and there never will be. All parties need to accept this reality.

Despite the scaremongering of some, all the available evidence demonstrates that midwife-led and GP/obstetrician-led care is a safe option for women assessed to be at low risk of complications, as is a planned birth either at home or in a small, local, stand alone, midwifery-led birthing centre. Despite the previously limited Commonwealth support for such approaches, they have already been successfully practised in Australia. As evidence, I refer senators to the recent review of the Ryde Midwifery Caseload Practice, in New South Wales. Western Australia has its own very successful community midwifery program, funded by the state government, which allows women in the program to birth at home with their midwife.

Midwife-led models of maternity care have been successfully implemented on a much wider scale in New Zealand, where the latest figures indicate that over three-quarters of all mothers choose a midwife to lead their maternity care. The British government has also recently committed to offering all mothers in the UK the choice of midwife-led care by the end of 2009. It is notable that in NZ obstetricians focus the majority of their work on riskier births, and there is a growing consensus there that this has been of benefit to the overall maternity services workforce.

Consultation and review processes in Western Australia and other states have highlighted the limits of state government’s capacity to holistically reform maternity services. To give an example, full and flexible use of the skills of midwives will require reforms to Medicare funding arrangements—reform that both the national Maternity Coalition and the Australian College of Midwives have been calling for. For more than a decade there has been an urgent need for the Commonwealth to drive reform in this area. Everyone recognised this; everyone except the Howard government.

A decade after the Senate’s own inquiry into childbirth procedures, we are finally moving forward at a national level. Earlier this year, building on the work already undertaken by state governments, the Australian Health Ministers Advisory Council endorsed a framework for the implementation of primary maternity services in Australia. This reform process will require strong action by the Australian government, and as such, I welcome the release of the Rudd government’s discussion paper on improving maternity services. The paper will guide a community consultation and review process at a national level. With all levels of government pulling in the same direction, and with all stakeholders involved in a national dialogue led by the Commonwealth, I have no doubt that we will finally make real progress in this critical area. This will deliver real benefits to mothers, babies and their families.