MATERNITY SERVICES FOR TEMPORARY WORKERS IN AUSTRALIA

Public hospitals in Melbourne, and in other parts of this country, have closed their doors to women who do not have Medicare.  Women who present needing care at a public hospital are being told they must pay an $11,000 deposit, or leave without being attended to.  They are told to go to a private obstetrician, and make a booking at a private hospital, with an estimated $15,000+ cost to the woman.

The more affordable alternative is private midwifery services for planned homebirth, costing around $5,000.  However, an estimated 20% of women who are planning homebirth need to be transferred to hospital when their care needs exceed the capacity of midwives in the home.  These women arrive, with their midwife, at a public hospital, because they have no other option.  The midwife's duty of care to the woman and her baby is to refer to an appropriate service; regardless of the cost. 

Women who are in Australia on temporary work visas, such as 457, must have private health insurance.  However, it seems that the available insurance policies are woefully inadequate when maternity services are needed.  Women who have spoken to independent midwives, seeking to arrange their intrapartum and immediate postnatal care, have said that they simply can't afford the hospital fees.

This situation is unacceptable!

The time of childbirth, more than any other time of life, requires skill from the care providers, leading to security for the mother.  Although 'birth is not an illness' (WHO Fortelesa Declaration 1985), illness can quickly arise in pregnancy and birth, threatening the lives of the mother and her child.   

The data that midwives send to the Victorian Government Perinatal Data Collection Unit, and similar units in other States and Territories, and sent on to the Australian Institute for Health and Welfare, Mothers and Babies reports, does not give a field to identify the woman who are ineligible to use the national free public hospital services.  The outcomes will never be reported - they are likely to remain under the radar.


Is there a solution?

I would suggest at the very least that public hospitals need a process by which overseas workers, many of whom are from the poorest countries of the world, are able to access affordable maternity and neonatal care.  Yes, midwives can provide basic primary care in the community, at an affordable rate.  But, when a woman needs specialist obstetric referral, surely a 'no frills' option can be provided by the public hospitals, at considerably less cost than what is on offer from Melbourne's plush private hospitals.

Your comments are appreciated.

Medicare review

The federal government health department has engaged consultants to review the incorporation of Medicare into midwifery practices.  Yesterday the MAMA practice was visited, and focus groups and interviews carried out with midwives and mothers.

I don't know if or when the public (you and I) will see any such reports, but this sort of review is expected a couple of years after major policy and funding changes by our government.

A midwife/maternal and child health nurse asked the reviewers to note that the maternity reform initiative, subsequent to the Maternity Services Review, is notable in its lack of public education or advertising.  The government's response to the Review was a  "$120.5 million Budget package Providing More Choice in Maternity Care – Access to Medicare and PBS for Midwives. This Budget package provides Australian women with more choice in maternity care whilst maintaining our strong record of safe, high quality maternity services."



More "choice in maternity care" is not accessible if women don't know about it.  Medicare rebate for midwife-attended births means nothing if midwives can't have visiting access to hospitals.  Yet the rationale for the reforms is more safety and better outcomes for mothers and babies: achieved through continuity of midwifery care.


Any other government health initiative, such as immunisation, or safe sleeping, or smoking cessation or ... is presented to the target audience public with the aid of professionally prepared TV and radio advertising, brochures, posters, and the like.

Midwife primary care with Medicare rebates is the best kept secret in the country. 

Why aren't there posters about continuity of care from a known midwife in places where women of childbearing age will see them? Why haven't we seen letters sent to doctors explaining how they can collaborate with midwives? Why are hospitals working harder than ever to actively prevent midwives from achieving visiting access? 

Your comments are, of course, welcome.

Letter to the Sunday Age

[In response to the front page article, 'Patient power troubles GPs', Sunday Age, 30/12/12]

I find it troubling that some doctors are not happy with the concept of independent experts who support a patient’s decision making in medical care. 

The statements by Dr Hambleton of the AMA suggest that he is attempting to protect the old ‘doctor knows best’ position of privilege in our society – perhaps that’s part of his job description?

I also take exception to Dr Hambleton’s questioning of “the need for private midwives to be escorting women during hospital births.”

I am one of those private midwives, and I would like to explain briefly why I provide primary maternity care, and attend birth, whether it occurs in hospital or the woman’s home.   

A midwife’s unique skill is the ability to work in harmony with the natural processes through pregnancy, birth, and the postnatal period.  Birth is not an illness.  The midwife’s duty includes promoting health, supporting wellness, and protecting the woman’s ability to do the work of bearing and nurturing her children.  Only when and if complications or illness are present does the midwife need to collaborate with medical and/or hospital systems, and only then with the woman’s informed consent.  Most women trust the midwife’s guidance, but there are grey areas in maternity care, just as there are in the world of GP doctors. 

The planned setting for birth is not set in concrete.  Many women who plan hospital births experience the ‘coming ready or not’ baby who arrives in all sorts of places, including the bathroom at home, the back seat of the family car, or the hospital carpark or lift.  Some women who plan homebirth need to change their plan and move to hospital, for all sorts of reasons.   

Midwives who practise privately, independent of the hospital system, are able to offer personal continuity throughout the episode of care and be with the woman in labour wherever she is.  Privately employed midwives seek to establish a partnership with each woman in our care, at a level that simply cannot be achieved without significant investment of time prior to the birth.  Privately employed midwives offer a distinct professional care package to each woman.  The women who employ us usually intend to give birth spontaneously,  without relying on medical pain management strategies, or artificial augmentation of the birth process, unless there is a valid reason at the time for such a decision to be made.

When private midwives ‘escort’ women to hospital, we have usually provided significant professional services for that woman through the prenatal period.  Several Medicare items give rebate for services such as the initial consultation, long or short antenatal checks, and the development of an individual maternity care plan.  The woman may have laboured at home, in the care of her private midwife, prior to traveling to hospital.  The woman knows her private midwife’s voice, and touch, and is able to be confident within the care plan.  The care plan includes the ongoing process of  informed decision making, with the wellbeing and safety of mother and child being the guiding principle. 

Postnatally the private midwife continues to provide expert professional services, within the primary maternity care relationship.  Postnatal Medicare items are available until the seventh week after the birth.

Dr Hambleton’s attempt to trivialise the private midwife’s role as “so someone can hold their hand” is offensive to me.  If I hold the hand of a labouring woman, it is a significant act of professional support for which that woman has employed me.

Joy Johnston

25 Eley Rd, Blackburn South Vic 3130

03 9808 9614

http://villagemidwife.blogspot.com.au/