I thank the member for Wide Bay for this important motion and acknowledge his work and that of his office for the Parliamentary Friends of Maternal Health, of which the member and I are co-chairs, alongside the member for Canberra.

The decline in maternity services in rural and remote Australia is of great concern to me and it’s of great concern to the people of Indi who I represent. Before coming to this place I worked for decades as a midwife, and a large part of that time as a caseload continuity of care midwife. I saw firsthand the importance for mothers, fathers and babies of having maternity services close to home, and with midwives working to their full scope of practice.

Just last week I attended a community meeting in Mansfield, where locals expressed their opposition to proposed mergers of regional health services across Victoria. While these decisions will be made at a state level, it is really important for us here, as federal representatives, to understand what amalgamations could mean for maternity services. In Mansfield there is a real fear that if the health service was amalgamated, it wouldn’t be long before it was seen as more efficient to centralise maternity services, with people forced to travel to Benalla or Shepparton or further afield to access maternity services and give birth. That would mean driving an hour away to give birth at a time when every minute counts. As the Mansfield GP-obstetrician, Dr Graham Slaney said, ‘When maternity services are centralised, it is often the start of a cascading centralisation and reduction in other health services such as anaesthesia and surgery.’ He added, ‘Maternity services are a key drawcard in recruiting and retaining junior doctors, skilled midwives and nurses to our country towns.’

We need models of maternity care that enable women to give birth close to home. In 2021 the Rural Health Commissioner, Professor Ruth Stewart, described in an editorial:

… more than 225 rural maternity units closed in Australia between 1992 and 2011 (more than a 40% reduction). These closures occurred in the face of accumulated evidence that small maternity services in rural areas are at least as safe as larger maternity services.

‘This is a critical point,’ she said, adding:

The narrative for closures is disconnected from the quality and safety evidence. These closures put birthing services further away for women in rural communities. Over those decades there was a 47% increase in babies born before arrival.

Essentially, that means on the side of the road. She continued:

The Queensland Rural Maternity Taskforce noted an increased risk of birth before arrival at hospitals for women who live 1 hour or more or less than 2 hours from maternity services.

We’ve known for a very long time that birth in small rural hospitals is not associated with higher risk of poor outcomes compared to birth in larger centres. Decades ago, Professor Sally Tracey did a population based study of 750,000 women and proved this categorically.

Recently, the Senate Standing Committee on Community Affairs’s report Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australiafound that, when women don’t have access to maternity care that meets their needs within a reasonable travel time, there are consequences. International research has backed this up, associating travel time exceeding one hour with poorer outcomes for mothers and their babies as well as with increased interventions in childbirth. This is at a time when we are trying to get childbirth to have as few interventions as possible.

Australian women have repeatedly called for continuity of care and carer access to evidence to make informed choices and to choose the model of care and make those choices collaboratively with their care providers. We have overwhelming evidence about the positive outcomes for mothers and babies through midwife led continuity-of-care models, countless RCTs, Cochrane Reviews and growing evidence that, in fact, good investment from this government now has positive outcomes for Aboriginal and Torres Strait Islander women through birthing-on-country programs. But models such as these should not be the exception; they should be the rule.

This motion calls for the removal of structural barriers to women receiving primary care, and I want to acknowledge that this government has done some great work in this area, the removal of collaborative agreements for nurse practitioners and midwives accessing Medicare being one example. But there’s more to do, and an urgent piece of work right now is to address the issue of professional indemnity insurance for midwives. We know that in the federal budget there were some big investments announced for midwifery, including claim costs for indemnity insurance. We need to make sure we get this right and that we don’t exclude women from home birth under this insurance arrangement. We need to be careful about the term ‘low risk’. We need to get it right and consult carefully.

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