To Senator Moore,
Inquiry into Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related Bills
The following submission outlines the concerns of members belonging to Peninsula Birth Support regarding the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009. Peninsula Birth Support is a group of maternity service consumers living on The Mornington Peninsula, Victoria. We aim to provide information about childbirth to the community and support to mothers interested in making informed choices during pregnancy and childbirth. We have observed that many mothers-to-be are not aware of the maternity care options available to them and we are gravely concerned that not only will the Bill make this situation worse, it will also eradicate some of the lesser known options, such as giving birth at home with the assistance of a qualified and registered midwife.
Presently independent midwives provide homebirth families with a series of antenatal and postnatal in-home appointments, as well as attending births at home and living on-call throughout the last weeks of their client’s pregnancies. These are highly trained medical professionals who come to a woman’s home, prepared to provide medical care if need be. They are the experts on normal physiological childbirth. In the rare event that a homebirth mother’s pregnancy or labour becomes high risk, independent midwives work with the mother and other medical care providers, such as obstetricians, to ensure that mother and baby are safe.
In contrast obstetricians are the experts of high risk pregnancies and birth complications. Few women are aware that they are able to hire a midwife and have a homebirth. Obstetrics has a monopoly over maternity services and many women’s initial medical contacts in pregnancy (such as General Practitioners) do not think to share information with their patients about homebirth or independent midwives. Low risk women are needlessly referred to obstetricians due to a lack of understanding in Australia about the two very different models of care obstetricians and independent midwives offer. As a result we have a national rate of homebirth that is under 2%.
Peninsula Birth Support aims to improve childbirth knowledge within the community to combat the lack of information provided to pregnant women about their options. However, there will be no point to our mission come July 2010 when The Midwife and Nurse Practitioner Bill comes into effect. This Bill is set to give obstetricians and GPs power over independent midwives (as outlined in the Health Legislation Amendment), leaving Australian families with no such thing as independent midwifery.
While the Australian government, in conjunction with the Australian Medical Association have stated that this Bill seeks to create collaborative arrangements between independent midwives and doctors, their version of collaboration gives doctors the power to determine whether or not a midwife may practice, and who she can and can’t care for. More alarming is the fact that this means Australian women will not have freedom of choice when it comes to who they wish to employ as their care provider during pregnancy and childbirth. The government is taking this right away and giving it to one group of service providers.
In no other arena of consumption would the government allow one group of service providers to control their competition. Birth attendant Kelly Winder summarised the situation thusly: “Giving obstetricians and GPs the power to choose who can homebirth with an independent midwife is tantamount to giving formula companies the power to choose who can breastfeed.” It is deplorable.
For the government to remove such choice from Australian women is ignorant, unjust and paternalistic. This Bill places doctors, rather than women, at the centre of maternity care. It suggests that the government believe doctors should make women’s minds up rather than leave women to make choices themselves, choices which directly concern their bodies and their babies. Further, it suggests that the government believes obstetrics is a superior service to independent midwifery. This is inaccurate (independent midwifery and homebirth have been shown to be safe according to peer reviewed medical journals[1]) and places many low risk women in danger of receiving unnecessary high risk interventions during pregnancy and birth, because this is what obstetricians specialise in: high risk cases.
The women within Peninsula Birth Support have had many and varied experiences of pregnancy and childbirth. Our group includes mothers who have given birth: in hospital, at home with an independent midwife and unassisted at home. We respect one another’s diverse birth choices regardless of whether we would choose the same for ourselves. All we ask of our government is that they do the same. Our government should respect a woman’s right to choose where she gives birth and who she hires to be her care provider. If the government are able to go forth with The Midwives Bill as it stands these rights will be taken from women and placed in the hands of doctors, many of whom are unsympathetic to homebirthing despite the medical literature which attests to the safety of homebirth attended by independent midwives.
If homebirth is to remain a feasible option for Australian women it is imperative that we have access to independent midwives. It is their independence which enables these midwives to provide such high-quality, personalised and in-home care!
Yours sincerely,
Peninsula Birth Support
[1] de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009.Kenneth C Johnson and Betty-Anne Daviss, Outcomes of planned home births with certified professional midwives: large prospective study in North America. British Medical Journal 2005;330:1416 (18 June); Macfarlane A, McCandlish R, Campbell R. Choosing between home and hospital delivery. There is no evidence that hospital is the safest place to give birth. British Medical Journal. 2000 Mar 18;320(7237):798; Olsen O, Jewell MD. [The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, dept. 7112, Copenhagen, Denmark, DK-2100 O. Home versus hospital birth. Cochrane Database Syst Rev 2000;(2).
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