LETTERS TO POLITICIANS

The following advice is from Justine Caines, President of Maternity Coalition, and leader in Homebirth Australia australianhomebirth@yahoo.com.au

To find your local Federal Politician, search the AEC website http://apps.aec.gov.au/esearch/


I suggest you send 2 separate letters. One to

Nicola Roxon
Minister for Health and Ageing
Parliament House
CANBERRA ACT 2600

In the letter to your local FEDERAL member you can cut and paste the contents but add in this to your local members letter.

Dear [NAME]

I ask you to represent my concerns to Health Minister, Nicola Roxon and please inform me of the outcome.

[Some suggested paragraphs, particularly for the local members:]

The Maternity Services Review handed down its report on February 21. This report made the 38th inquiry into maternity services since 1985.

I believe the only issue more investigated into is petrol prices. The needs of women and their babies should come before that of vested interest groups.

The Report examines enhancing midwifery practice, which is long overdue. The care of a known midwife from early pregnancy through labour and birth and the early post-natal period has considerable benefits. These benefits can be be measured financially through a reduction in unnecessary surgical birth and other interventions. More subtle but important benefits are increased rates of bonding and breastfeeding, lower rates of post-natal depression and greater satisfaction with the experience of childbirth. This greatly assists a woman entering motherhood.

Unusually the Report does not examine the urgent need to redress obstetric practice in Australia. Many practices currently employed by obstetricians are not based on sound research evidence, but rather custom and practice. This leads to varied outcomes, for example one hospital may have a caesarean section rate of 16% while another of similar size and capacity has a rate of 30%. Maternity outcomes in Australia are based on post-code. There is currently not a ‘bench-mark’ for quality and safety. The cost of maternity care is spiralling out of control. The Medicare Safety-net was established in 2004 to assist Australian families with the cost of health care. In just over 4 years payments made to Obstetricians under the Medicare Benefits Schedule have increased by approximately 300%. Such increases are not sustainable and have the capacity to see the demise of the Medicare Safety-net, something that will impact many Australians.

Private health costs have risen again this week. The cost of maternity care is considerable. Childbirth is the highest volume area of health and accounts for the greatest number of bed stays. Private maternity care is totally anti-competitive. As a taxpayer who funds the Governments 30% rebate on private health insurance premiums I object to a system that is unnecessarily expensive, not based on evidence and gives women no choice but medically dominated services.

The report of the Maternity Services Review states that the Government will not support the costs of private homebirth services under the Medicare Benefits Schedule, nor will they provide indemnity insurance assistance to midwives working in private practice. Midwives in private practice are the only health professionals in Australia currently without indemnity insurance. This is not due to their pracitce, or claims history, it is simply due to the fact that they are small in number. Medical practitioners and their clients currently enjoy indemnity protection at an estimated cost of $500 Million.

There are currently plans to establish a national registration body for health professionals by mid next year. An appropriate requirement for registration is professional indemnity insurance. If midwives in private practice are not assisted, they will be prevented from registering. If they practice will unregistered they face a jail term. If national registration proceeds as planned women choosing homebirth will be unable to access a registered midwife, and essentially the practice will go ‘underground’. It is not acceptable that women are unable to choose the care of a registered midwife to give birth at home. Homebirth is a nationally funded option in the United Kingdom, Canada, New Zealand and The Netherlands. I ask that you support a woman’s right to choose where and with whom she gives birth.

I ask you to investigate my concerns and make representations to Health Minister Roxon as a matter if urgency.

WHAT CAN I DO?

What can I do in response to the Report of the Maternity Services Review?

This is a question that many are asking. Anyone coming to this blog is likely to have some interest in midwives private practices and homebirth. Many of you will have written submissions to the Review. Please:
1. go to the Report and compare what you said in your submission with what is recommended in the Report. Then write to the Health Minister telling her how the Report has ignored consumer preference and informed choice, and sidestepped evidence in support of the opinion of powerful professional lobby groups.
2. contact your maternity groups - Maternity Coalition or professional, and find out what response is being made to the Report and its recommendations.
3. be ready to respond with Letters to Editors of news papers, as well as blogs to opinion pieces, such as The Australian and ABC Radio UNLEASHED Note that there are 133 comments in response to Alison Leemen's piece 'Homebirth Ban' which went to air only a week ago! Homebirth and private midwifery practice are issues that our community cannot afford to ignore. As Leemen says,
"The government can't ban homebirth any more than it can ban sex, but by banning professional, registered midwives from attending homebirths, it greatly increases risk.

"Not funding homebirth is just bad policy: cost-ineffective to Australian taxpayers and unfair to Australian women. But making homebirth illegal is paternalistic, internationally isolated and dangerous."


Now is the time for everyone who cares about homebirth and autonomous midwifery practice to take action. If we don't, we stand to lose what little access we have.
Joy Johnston

Homebirths may have to be secret

In the Australian today


Adam Cresswell, Health editor | March 02, 2009

Article from: The Australian
"HUNDREDS of women each year who choose to give birth in their homes are likely to face greater medical danger for themselves and their babies with the introduction of regulations that could force the practice underground. [continued]



Thankyou Adam Cresswell for this article.

There are several options open to the government, to avoid criminalisation of independent midwifery practice:
*1. To extend to midwives the same indemnity support that they already provide doctors, as noted by Cresswell
*2. To reform the insurance system, making a 'no fault' scheme similar to the TAC, that is linked to all services provided by health professional. This removes claims from the law courts. New Zealand has such a scheme by which anyone who sustains injury or loss as a result of health care is able to receive compensation, without having to sue the person(s) who they consider responsible (a very complex and difficult process).
*3. To amend the requirements of the new national health registration legislation, so that indemnity insurance is not mandated.

Options 1 and 2 are rational and do-able. Option 3 makes no more sense than does the deregistration of midwives who are offering safe and effective maternity care.

Joy Johnston

Homebirth ban - ABC Unleashed

27 February 2009 Homebirth ban
Author Alison Leemen

"The Maternity Services Review report, released last weekend, was an attempt to delivery continuity of care and midwife-led services to more Australian women. In so doing, it has stripped that very same care and service from the only women who currently have it - homebirth mums.

"The fact that it did this in the face of having received the majority of its submissions from homebirth parents is galling and speaks volumes for the way "public consultation" occurs in this country. But the fact that the report's recommendations, if accepted by the Government and made law, would criminalise the high quality care currently delivered to women who choose to give birth at home by registered, professional, independent midwives to their clients is radical and dangerous.

"Good intentions have paved the way. The MSR was established partly in response to rising birth intervention rates and widespread concern that women were being poorly served by a maternity care system that was fragmented, expensive and increasingly medicalised.

"But the process became hijacked by ...

[continued]

...

"Homebirth with an independent midwife is a great model of care for lots of reasons, key among them that it provides continuity of care with a known carer - something the Maternity Services Review says it wants to see in hospital -based models. So why is it killing off the only model that reliably delivers that care?

"Giving birth at home with a highly skilled and qualified midwife is not new or radical. Outlawing it is."

[Thankyou ABC Unleashed for speaking out.]

From The Border Watch, Mt Gambier SA

Greater role for midwives proposed

Posted on February 25, 2009, 8:08am

"Both the Australian Nursing Federation (ANF) and the Rural Doctors Association of Australia (RDAA) have welcomed the newly released Maternity Services Review Report, which focuses on an expanded role for midwives and improving access to maternity services in rural areas." continued

For critical comment on this article and the MSR Report, go to http://www.homebirth.net.au/

ACM MEDIA RELEASE – NATIONAL MATERNITY REVIEW

The Australian College of Midwives commends the Government for undertaking this much needed review of maternity services in Australia and for listening to the voices of the women and their families.
“The Review has read a large number of submissions and deliberated over many complex and at times controversial issues,” said Professor Pat Brodie, President of the Australian College of Midwives.
“We endorse and commend the recommendation to continue to deliver maternity services in this country within a collaborative framework based on informed choice, and expanded access for women to continuity of care by a known midwife.”

“We applaud the Review’s determination to close the gap on disadvantage for Aboriginal and Torres Strait Islander mothers and babies in partnership with Indigenous people themselves. We stand ready to work with the government, medical professionals and with Aboriginal women and their communities to help make this a reality.”
Professor Brodie said, “Also vital is the recommendation relating to improving the access of rural women to safe, collaborative maternity care as close as possible to where they live. Roadside births are on the rise with so many rural maternity services having been closed. This trend must be reversed.”

“The proposed extension of MBS and PBS access for midwives is essential to support the full contribution that midwives can make to maternity care in urban, rural and remote areas such as the Review is proposing,” said Professor Brodie. “We urge the government to make this a reality as soon as possible and to thereby bring Australia into line with other developed countries.

“The market failure in providing insurance for privately practising midwives also needs to be addressed urgently and we welcome the Review’s recommendation to ensure that suitable professional Indemnity Insurance is available for midwives,” said Professor Brodie.

Over the past 5 years a robust quality framework has been developed for midwives involving regulators, the professions and consumers. This framework includes national competency standards, Codes of Ethics and Professional Conduct for midwives, evidence based consultation and referral guidelines, a national continuing competence framework, and Midwifery Practice Review (a form of professional credentialing). “This quality framework provides assurance that midwives who choose to take up responsibility for providing continuity of care, provide safe and professional primary care to women and collaborate with doctors and other health professionals for the benefit of individual women and babies in their care.” Professor Brodie said.

“It’s not about women being cared for by midwives instead of doctors” Professor Brodie added. “Midwifery care is something all women need and stand to benefit from. Continuity of midwifery care is about each woman having a known midwife who provides her care throughout her pregnancy, her labour and birth and the all important follow up care at home after the birth. Midwives respect and value the expertise of obstetricians and other health professionals. When women they are caring for need medical attention, midwives work closely with doctors to ensure the individual woman and her baby have optimal outcomes.”

The effectiveness of midwifery care received the highest scientific endorsement in October 2008 when a systematic review of 11 randomised controlled trials and over 12,000 women from around the world demonstrated that outcomes for women receiving continuity of care from known midwives were better than for women who received fragmented care from multiple midwives and doctors. There is no longer any doubt that continuity of midwifery care offers women considerable advantages and supports great beginnings for their babies and families.

In the past 20 years there have been over 20 maternity reviews at State and Commonwealth level, and many of these have not been acted on. “Now is the time to stop talking and start acting. We urge the government to listen to the needs of women and their families and make sure that these recommendations are acted upon. The time has come to give all women the choice of continuity of care from a known midwife, with seamless access to medical expertise as required” said Professor Brodie.

Contact: Media Spokesperson, Australian College of Midwives, Assoc Professor Hannah Dahlen 0407 643 943,
President, Australian College of Midwives, Professor Pat Brodie 043 418 1953, Executive Officer, Australian College of Midwives, Dr Barbara Vernon 0438 855 529,

RECOMMENDATIONS OF THE MATERNITY SERVICES REPORT

Recommendation 1:
That the Australian Government, in consultation with states and territories and key stakeholders, agree and implement arrangements for consistent, comprehensive national data collection, monitoring and review, for maternal and perinatal mortality and morbidity.

Recommendation 2:
That the Australian Government, in consultation with states and territories and key stakeholders, initiate targeted research aimed at improving the quality and safety of maternity services in select key priority areas, such as evidence around interventions, particularly caesarean sections, and maternal experience and outcomes, including from postnatal care.

Recommendation 3:
As a priority, that the National Health and Medical Research Council (NHMRC) develop national multidisciplinary guidelines for maternity care to promote consistent standards of practice, quality and safety in collaborative team models. These guidelines are to be agreed by the professions involved, in consultation with consumers and state and territory governments.

Recommendation 4:
That, in developing the National Maternity Services Plan, consideration be given to the demand for, and availability of, a range of models of care including birthing centres.

Recommendation 5:
That, given the role of the states and territories in the provision of maternity services in rural areas, the availability of rural maternity services is a priority area for the Plan, requiring the engagement of states and territories.

Recommendation 6:
That provision of maternity services be considered in the context of all governments’ commitment to close the gap on Indigenous disadvantage, and be developed in partnership with Indigenous people and their representative organisations.

Recommendation 7:
In consultation with relevant state or territory governments, that consideration be given to funding expansion of Indigenous maternity care programs, based on current successful models, within a research and evaluation framework.

Recommendation 8:
That, in any initiatives that are aimed at supporting an expansion or upskilling of the maternity services workforce, particular focus is given to supporting an increased number of Indigenous people as members of the maternity workforce, across a range of roles.

Recommendation 9:
That all professional bodies and employers ensure that all health professionals and other staff involved in the delivery of maternity care receive cultural awareness training.

Recommendation 10:
That all professional bodies involved in the education and training of the maternity workforce ensure that cultural awareness training is a core component of their curricula.

Recommendation 11:
That consideration be given to improving the range of birthing and other pregnancy-related information and resources, including those on the internet, that is made available to assist women in informed decision making; with any information materials specifically recognising the needs of population subgroups such as culturally and linguistically diverse communities, women with a disability, Indigenous and teenage mothers.

Recommendation 12:
That consideration be given to the establishment of a single, integrated pregnancy-related telephone support line for consumers, possibly as part of the National Health Call Centre, providing both clinical and non-clinical support services, complemented by triage to a number of existing specialised support services.

Recommendation 13:
That in order to lengthen the duration of breastfeeding, further evaluation be undertaken to identify the health care or community settings in which breastfeeding information and support are most effectively received, with a particular priority on consulting and supporting women from diverse cultural and socioeconomic backgrounds.

Recommendation 14:
That the development of national maternity care guidelines (Recommendation 3 above) consider the Perinatal Society of Australia and New Zealand Clinical Practice Guideline for Perinatal Mortality Audit.

Recommendation 15:
That consideration be given to support for the rural maternity workforce to obtain and maintain appropriate training and skills.

Recommendation 16:
That consideration be given to identifying the competencies and credentialing required for advanced midwifery practice.

Recommendation 17:
That, noting the potential issues to be resolved including the potential interaction with Private Health Insurance arrangements, the Australian Government gives consideration to arrangements, including MBS and PBS access, that could support an expanded role for appropriately qualified and skilled midwives, within collaborative team-based models.

Recommendation 18:
That, in the interim, while a risk profile for midwife professional indemnity insurance premiums is being developed, consideration be given to Commonwealth support to ensure that suitable professional indemnity insurance is available for appropriately qualified and skilled midwives operating in collaborative team-based models. Consideration would include both period and quantum of funding.