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Tuesday, 13 June 1989
Page: 3894


Senator JENKINS(8.00) —The Senate this evening is debating cognately the Community Services and Health Legislation Amendment Bill 1989, the Supported Accommodation Assistance Bill 1989 and the Aged or Disabled Persons Homes Amendment Bill 1988. I wish to restrict my remarks to two amendments to this package of legislation. In the first case I wish to address my remarks to the Australian Democrats' amendment to the motion for the second reading of the Community Services and Health Legislation Amendment Bill and speak to the motion. The amendment states:

but the Senate is of the opinion that women who choose to give birth at home are disadvantaged because of their ineligibility for medicare rebates for the services of a midwife, and the Government should take urgent action to remedy this unfairness.

Homebirth is an alternative that a growing number of women are choosing. In Western Australia, in particular, women are choosing the alternative of the homebirth rather than a hospital birth. But this means engaging the services of a midwife. If a woman has a general practitioner or a specialist to assist her to give birth, she can claim a Medicare rebate. But if a qualified midwife assists in the homebirth, she is not eligible for a Medicare rebate. It is indeed unfortunate that doctors, for the most part, do not choose to assist women in homebirth. I know that there are exceptions but they are very much in the minority.

In assisting a homebirth, a qualified midwife will be present for some hours during labour, as well as providing antenatal and postnatal support which, of course, can be complementary to any care also given by a general practitioner or a specialist. Because there is no Medicare rebate, midwives tend to charge minimal fees for a homebirth. I have even heard that they have charged virtually no fees at all. Nonetheless, the result of this situation is a case of discrimination against women who cannot afford to have a homebirth.

I point out to the Senate that an increasing number of women are recognising the advantages of a homebirth. For a woman to give birth in her own home in familiar surroundings far away from a hospital atmosphere results in a more relaxed situation. Indeed it is now recognised that the woman herself can be better off in such circumstances. Of course, so can the newborn baby. Homebirth is not for everyone but some women want this. Other women feel more secure in a hospital situation.

As far as possible the woman concerned, if she is to have a homebirth, must expect a relatively uncomplicated birth. Of course, should this not eventuate and should it be deemed necessary for the woman to be transferred to hospital, a midwife can always arrange this. As the majority of births are what one could categorise as normal and, indeed, as they are more likely to be normal if unnecessary medical intervention does not occur, there is no reason why a woman who chooses a homebirth should not be allowed to have it.

I also point out that in Western Australia midwives have access to hospitals. In fact, if the woman is to be transferred to a hospital the midwife can assist at the hospital. With conscientious prenatal care most complications or difficulties that are likely to arise are, in this day and age, predictable. Women greatly appreciate the special personal support which can be given by a midwife. A lot of women do not see themselves as sick patients. They recognise that hospital treatment may be necessary but for normal child birth a lot of women do not regard it as necessary. Rather, they see themselves as taking part in a natural and beautiful process which can be uncomfortable, even painful. It can make a woman feel particularly vulnerable. Therefore, that is all the more reason for women to require the sympathetic support that they can have from a midwife.

A qualified midwife has more than enough qualifications and knowledge of gynaecology and obstetrics to be able to assist a woman in the birth process. If things go wrong-and unfortunately they can go wrong at times-then most women would appreciate being able to be in a hospital and surrounded by the latest equipment. If this happens in Western Australia, the woman can still have her midwife with her as in Western Australia midwives have delivery rights in hospitals.

It has been pointed out to me that Western Australia would be a good State in which to have a pilot scheme involving an increased use of midwives. I would like to draw the Senate's attention to a task force which is currently reviewing obstetric, neonatal and gynaecological services in Western Australia. The aims of the task force are to assess the quality of care currently being provided; to determine whether resources are being used effectively; to consider the needs of groups requiring special attention, such as adolescents, Aboriginal people, women from non-English speaking backgrounds, the disabled and those who are economically disadvantaged or who reside in isolated areas; and to investigate the possibility of alternative types of services which will allow for increased consumer choice. That is what I am talking about: the ability of women to choose a homebirth if this is what they want.

The terms of reference and objectives of the task force include investigation of the current hospital obstetric practices, including the frequency of intervention in child birth; the provision of medical services to pregnant women in emergency situations when giving birth in a non-hospital setting; and the role and range of duties undertaken by midwives, including the role, training and access to hospital of independent midwives. The Democrats are of the opinion that a woman who chooses to give birth at home should have access to Medicare rebates by being able to claim for the services of a qualified midwife.

I would like to address some remarks to the amendment put forward by Senator Boswell wherein he moved that proposed amendments contained in part 5 of the Community Services and Health Legislation Amendment Bill 1989 be referred to the Senate Standing Committee on Community Affairs for inquiry and report by the first sitting day in October 1989. The Democrats strongly support the thrust of the amendments put forward by the Government to part 5 of this legislation, those relating to accommodation for the disabled. But we have some concerns. We believe that integrated accommodation for disabled persons needs both adequate funding and an assurance that the service provisions by the non-government sector are of the highest quality. Senator Boswell's amendment to this part of the legislation would mean that a Senate committee would look into aspects such as these. I point out that in the Australian Capital Territory it costs on average $11,000 per person in integrated housing per annum. It is double that amount in the States because these service provisions are not subsidised by other services as they are in the Australian Capital Territory.

Once disabled persons have been de-institutionalised it is important that there be a close tie-up between home and community care and the attendant care program. There may be problems in instituting these changes, which the Democrats support, because people who are used to institutionalised care may find it difficult to adjust to non-institutionalised care. We find that problem right across the board. It is well known that people who spend a large part of their lives in institutions as children find it hard to cope with life outside an institution upon reaching adulthood. We just have to look at the statistics in our prison system to see how many of those who are, unfortunately, regular clients of that system spent a part of their lives in institutions. There have been criticisms that the Disability Services Act is too inflexible and it is imperative that accommodation choice be individually based. Within the system there must be a choice of bigger homes, although the Democrats believe that there should be no more than 20 persons in each home. This is particularly important in the country and for emergency accommodation where small homes of four persons may not be appropriate. The question must also be asked as to why indexation remains at the discretion of the Minister.

We certainly support this matter being referred to a Senate standing committee, but we believe that it should be sequential and not concurrent. In other words, the Democrats will pass part 5 of the legislation, but will also vote in favour of these matters being referred to the Senate Standing Committee on Community Affairs. The final implementation of this amending legislation will not occur until 1992, so there is just time for considerations at the start of its implementation. Besides which, guidelines will be associated with the legislation and it will be possible for the Committee to assist in setting those guidelines. However, as I understand it, Senator Boswell has agreed to the date being changed. Having spoken with the Chairman of the Committee, Senator Zakharov, I have found that she is of the opinion-and I would agree with her; I cannot speak for the Committee because it has not met to discuss Senator Boswell's amendment-that the Committee could not possibly look at and report on these considerations by the first sitting day in October 1989, so we are seeking to have that date changed to the first sitting day in March 1990.