Recently Federal Health Minister Nicola Roxon announced a review into maternity services. The Minister has given support to considerable maternity reform, particularly the appropriate usage of the midwifery workforce. The discussion paper raises issues such as Medicare funding for midwives, admitting and prescribing rights and indemnity insurance to enable private practice.
So far the consumer voice has not been heard. Instead, media has focussed on the turf war between the medical and midwifery professions. For many years, maternity services, and one could argue health per se, has been about doctors. Interestingly, the use of medical staff, particularly specialists, is not necessary for the majority of women, nor is it supported by evidence.
The vast majority of Australian women will be healthy and experience a normal pregnancy. The majority of women could also give birth normally. Sadly over 30% of women in Australia have their baby removed via surgery. Only 58.5% of women in Australia have a spontaneous vaginal birth. Considering our developed status, this is a telling statistic.
For the best part of 20 years, health policy has been written with a consumer focus, often with language that places the consumer at the centre. In practice this is often not achieved. Within maternity care it is rarely achieved. Australian women do not have choice. Medicare funding channels the majority of women into mainstream medically dominated care. In New Zealand, a baby bonus type health payment enables a pregnant woman to choose a “Lead Maternity Carer”. NZ women can choose a midwife, GP or obstetrician.
The proposed reforms will enable women to choose midwifery care. Considering the currently well-supported options of procedural GP’s and specialists, for the first time Australian women will actually have a choice. Importantly many women may also have the option of giving birth in their local community.
In the last 10 years, more than 120 rural maternity units have closed, causing many women and their families considerable emotional and financial distress. The Howard Government’s refusal to recognise the registered “capacity” of midwives prevented a safe option for at least 75% of women.
As a consumer advocate who has devoted close to 9 years to improving maternity services, I salute Minister Roxon. The Minister has listened to women across Australia. I now hope we see professional groups doing the same. The paternalistic bleating that ‘the safety of a woman and child is paramount’ has worn thin. The truth is the turf war between doctors and midwives has never been in the interests of women or babies. It has been about the protection of the status quo versus an ideological difference in the way services should operate.
Women must be able to choose with who and where they share the intimate act of birth. Enabling all maternity health professionals funding, indemnity insurance and admitting/prescribing rights is long overdue.
With all players participating on a level playing field, women can only benefit. Once reform is realised, I can rest. I have never had an interest in the actual choice women make, just the ability for them to make it. After all a single option of medical care is not choice.
Justine Caines is a mother of seven children aged four weeks to seven years living in rural NSW, and the author of Medical Indemnity in Australia: How one birth changed maternity services. She is a past president of Maternity Coalition Inc, Current Secretary of Homebirth Australia and the founder and convenor of What Women Want (Australia), a political party devoted to advancing women.
Where would Australian women be if it wasn’t for the wonderful women campaigners and leaders like Justine Caines?
A true blue Aussie who speaks out for justice for all women. A leader with strength and credibility and most of all personal experience and knowledge about a system that has been ground to a halt in this country. Controlled by greed, power and domininace of one medical profession.
If Nicola Roxon is true to her word it is time for change, time for the medical profession to take a look at where their skills are genuinely required. It’s time for the Medicare system to be revived so that medicine does not soley own and control the health system. It’s time to recognise the value of other skilled practitioners, such as Midwives, Nurses and Maternal and Child Health Nurses to Australian Society.
It is also time to realise that some women and midwives do work together in a private arrangement, they should not be excluded because unavailable Professional Indemnity globally. The Northern Territory actually prevents midwives from practising with women privately because of legilsation dictates PI “must” be available. Imagine if the same principle was applied to the medical profession, pharmacy , dental and others. Would these groups accept it as a fete au comple?
Thanks Justine for being the voice of millions of Australians. The Maternity Coalition started with some dedicated women and midwives when Birthing in Victoria became intolerable. Justine later lead Maternity Coalition into a new era and persisted in making MC the leading Australian consumer group. Now she leads an emerging Political Party – “What Women Want” – into another new era.
Without the Justine Caines of this country with her ability to lead the voice of women and others disatisfied with Australian Maternity services, women would continue to be dominated by the medical profession and their strong hold on the Medicare system.
Finally the truth is being told about our appalling maternity services. Other voices are being heard. Our system has long been about power, vested financial interests, hierarchy and status. Giving midwives true autonomy with prescribing rights, medicare funding and insurance to practice will revolutionise birth in this country. Bring it on!!!!!
It is amazing to think that woman might actually have a choice in their maternity care after all this time. Women in our regional area often say that they are asked by their GP when they are pregnant whether they have private insurance, in which case they are just given a referal to the local private hospital where c/s rates are rumoured to be above 60% or if they don’t they have public care and see their GP and any number of different doctors in the public hospital. To be able to have real choice to have a known midwife will be amazing! Lets hope this review really enables the change to happen.
I am an Australain midwife working in New Zealand as I cannot care for women and babies as evidence and physiology says i should in my own country but I remain hopefull that one day soon – thanks to Nicola Roxon I maybe accord the rights, support and access to do as Justine Caines explains.
Well done Justine for your tireless efforts in raising the issues of maternity reform. I am 23 weeks pregnant and planning a homebirth which will cost me over $4000 – money which, if midwifery were publically funded (as it is in NZ), could be better spent on the costs of raising my child and keeping me out of the workforce longer for the numerous benefits of breastfeeding and fulltime mothering. Keep up the good work!