Wednesday, 16 October 2019
Medical and Midwife Indemnity Legislation Amendment Bill 2019; Second Reading
I thank the member for Parramatta for the comments she has just made. I'd like to add my voice to the discussion on this bill, the Medical and Midwife Indemnity Legislation Amendment Bill 2019. Firstly, I congratulate Minister Hunt on this bill, which has the full support of the AMA, the Australian College of Midwives, the Australian College of GPs, and respective allied health and midwifery leaders. And I very much support the amendment that has been put forward by the member for McMahon and was spoken to just now by the member for Parramatta.
This bill addresses a key problem that is occurring in our maternity services, and I'm very pleased to see that this problem is being addressed. It's so important to ensure that Australian women have access to the highest quality of maternity care. We know that the highest quality of maternity care has the woman in the right place at the right time with the right health professionals, and we know that the right health professionals are a blend of midwives, obstetricians and allied health professionals. This bill helps us to undertake the work that is required to remove what was a systemic barrier for midwives in particular to accessing the indemnity insurance that they needed in order to practise to the full capacity of their scope as a midwife in private practice.
This is really important because what we need are models of care in our maternity system that allow choice for women. When we have choice for women, we give women control of their immediate circumstances. When we have choice for women, we allow them to see practitioners in addition to the traditional model of medical care that has largely been available in our health system. One of the things that we know about midwifery care—and I speak on this with some passion, as I practised as a midwife for more than 20 years prior to undertaking an academic career—is that midwives are frontline public health practitioners. Midwives are the people who introduce women to the essential public health aspects of vaccination, breastfeeding and early parenting whereby the most essential parts of a person's life are set up. We know, in fact, that the most essential determinants of a person's future health are set up during pregnancy and the early parenting period. Midwives play a key role in ensuring that women enter their pregnancy, give birth and then establish early parenting with their front foot forward. So I am really pleased to have the opportunity to speak to this bill in the House.
I really want to highlight today the importance of the role of the midwife, including the ways that midwives work in continuity-of-care models. That includes private practice and, indeed, homebirth, which is a part of private practice. I want to draw the attention of the House to the Cochrane systematic review of midwifery practice that was undertaken with more than 12,000 people. It showed very, very clearly that, when we have a midwife engaged in the care of healthy women, we have significant improvements to women's health. There are significant improvements that reduce the number of fetal deaths. Something that we were marking in this House yesterday was the reduction of stillbirths in our population. The Cochrane review indicated that when we have midwives leading the care of women we have a significant reduction in those deaths—in fact, 12 per cent. That's a very, very important thing.
What's also important is that, when we have midwives leading the care of women in collaboration with their medical colleagues, we reduce the numbers of operative births and we reduce the number of instances of regional anaesthesia that are required during childbirth, and, when we do that, of course we reduce the morbidity that women experience. That is extremely important to the broader health system and the ongoing care of our women.
Removing a structural barrier to accessing full insurance coverage is so important, and so is fostering models of midwifery care that can be useful in rural communities such as where I live. It is a clear signal to midwives that this government takes their role very, very seriously, and midwives need that clear signal. Right now in my electorate, we have severe workforce shortages in our rural midwifery workforce. In fact, Australian Institute of Health and Welfare data from 2017 shows that in major cities we have 16 midwives to every 100,000 people. In inner regional and outer regional areas, that number falls to six.
In Yarrawonga, right next door to my electorate of Indi, the health service announced last week that they will be closing the maternity services come January 2020. The reason for that is they have no midwives. That means that the GPs in that town have no midwives to support them either. This is a symbiotic relationship. Midwives and GPs in rural areas work hand in hand. Midwives and rural obstetricians work hand in hand. With the loss of maternity services in Yarrawonga comes pressure on my home town of Wangaratta, a regional health service which itself is experiencing an extreme shortage of midwives. Right now they're paying exorbitant amounts of money to bring in agency midwives from Melbourne to staff the maternity wards. That puts enormous pressure on the health service, it puts enormous pressure on the longer-term midwives and it puts enormous pressure on the obstetricians who are taking care of those women. So I'm really concerned about that. We know that without midwives the quality of care for both healthy women and women at medical risk becomes something that is not optimised. A bill such as this gives a clear signal to midwives that they're valued in the system, and I really appreciate that.
I would particularly like to highlight today the role of midwife led models of care and I had the opportunity to mention this to Minister Hunt a few weeks ago. A midwife led model of care is a continuity model, in which a woman gets to meet a midwife right at the beginning of her pregnancy and that midwife, and a small group of backup midwives, looks after her throughout her pregnancy and throughout the birthing period and perinatal period. This is incredibly important, because the international research is very clear that, when a midwife is known to a woman, all aspects of her care are improved. Most importantly, her satisfaction with care is improved. I've done substantial research around fear and anxiety in childbirth, and the one thing that we know in reducing a woman's fear, anxiety and subsequent perinatal mental distress—and indeed perinatal anxiety and depression—is if she has confidence in the care that she is given. So this is extremely important.
Again, bringing it back to my electorate of Indi, I'm very proud to say that in my early days as a midwife there I was part of a team that established a continuity of midwife care model called the Wangaratta community midwife care program. It's the longest-running rural continuity of midwife care program in Australia and it recently celebrated its 20-year anniversary, which I was very proud to attend. I pay tribute to the midwives who have continued to offer that model of care. That model of care can be enhanced by a bill such as this, because it means that privately practising midwives who are not part of the traditional model that generally operates out of a hospital can work in a model such as this with the full security of indemnity insurance. Perhaps some of midwives who are no longer able to work in Yarrawonga can now register as privately practising midwives and join that program in Wangaratta, to offer the care that is no longer available in Yarrawonga and to have the backup of services of the Wangaratta hospital.
So a bill such as this is very practical and useful. But I would add my voice to that of the member for Parramatta and say that the bill could go a bit further and ensure that homebirth services are also included in this—homebirth services that are backed up by the Australian College of Midwives, with all of the quality assurance that goes with the registration required to be a homebirth midwife. Homebirthing is not something that most women want. It's something that some women want. Some women want it because they’ve been disenfranchised by the traditional models of care. I think that that, if this bill was able to include midwives in private practice offering homebirths, that would be a very welcome addition to a small but significant number of women.
That small number of women includes some women who undertake freebirthing, birthing without a midwife or a medical practitioner at all, because they're too afraid to go to a hospital. That's a small number of women, but, significantly, those women are at great risk of incurring problems to themselves and their baby. Wherever possible, of course, we want women to have the care of a fully professional midwife with all of the training and skills that they bring. As I said before, the Cochrane systematic review on midwife-led models of care has significant advantages for women, and I am very pleased that I can stand here as a midwife and support this bill.
In addition to normalising and humanising birth, the contribution of midwives to the quality and safety of health care is absolutely substantial. And the contribution that we in this House, as policymakers who really wish to improve maternity services, can make is substantial. Any way that we can remove systematic barriers to having the best possible team looking after the women in our care in the public health system is extremely important. This bill contributes to the opportunities that we can create across our health system, and I support this bill wholeheartedly, with the addition of this amendment if we can possibly come to some agreement on that.
That's really all I want to say today about this. As a midwife, as someone who has practised substantially in this field, and as someone who still has very strong links into the rural community of Indi, where I'm very privileged to be the member, I want to point out to this House that the midwifery workforce is currently under enormous stress. Anything that we can do to provide financing, increase the numbers of midwives trained in our rural areas and increase the opportunities for midwives from the city to consider a career in rural health services would be most welcome, and any way that we can contribute to increasing the choices that women can have as they approach the most important period of their life—giving birth to a baby and early parenting, including breastfeeding and all of the aspects of public health—is extremely important.
The final thing I want to say is that a midwife's role goes beyond even that. The public health role of midwife, including the role that they can play in women speaking to them of domestic violence and in putting in early intervention around aspects of family life that can increase the likelihood of a small child having a higher quality of life, is incredibly important. So I add my voice to those others in the House today to commend the minister for this bill, to commend the collaboration that's happened across the aisles and to commend my colleagues in medicine, midwifery and allied health for their collaboration in drafting this piece of legislation.