Dr HAINES (Indi) (18:51):
I rise in support of the Medical and Midwife Indemnity Legislation Amendment Bill 2021. This bill amends the Medical Indemnity Act 2002 and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 to expand eligibility for claims against privately practising midwives under the Commonwealth’s medical and midwife indemnity schemes.
Specifically, this bill amends the Medical Indemnity Act to ensure that claims against midwives in private practice whose registration is not endorsed by the Nursing and Midwifery Board of Australia to prescribe scheduled medicines, registered-only midwives and midwives covered under their own insurance contract are now eligible under the Allied Health High Cost Claim Indemnity Scheme and the Allied Health Exceptional Claims Indemnity Scheme where the claim relates to incidents that occurred on or from 1 July 2020.
This bill also amends the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 to expand the Midwife Professional Indemnity Scheme and the Midwife Professional Indemnity Scheme Run-off Cover Commonwealth Contributions Scheme, also known as the midwife schemes, to remove criteria relating to the employment arrangement of midwives that have resulted in certain privately practising midwives being excluded from the midwife schemes.
Importantly, this amendment will enable key Aboriginal community controlled health services to choose to access professional indemnity insurance for their employed midwives who have been endorsed by the Nursing and Midwifery Board of Australia. These changes support flexibility in arrangements and supports midwives to work in a variety of different engagements without their indemnity insurance being a barrier.
This bill provides certainty to insurers of the Commonwealth’s ongoing commitment to subsidise the costs associated with medical negligence claims against privately practising midwives, further incentivising insurers to provide professional indemnity insurance in midwives in private practice. This bill is being developed in consultation with the Australian College of Midwives.
I want to congratulate the minister and his office on bringing forward this bill. I want to note the minister sharing with the House that he is the son of a nurse and a midwife. I want to note that that shows, because he seems to truly understand the role of a midwife. I know that, because of his comments when he said, ‘This is about giving mums-to-be choice and control. That’s what is so fundamentally important as well as protection.’ Midwives know that, and the minister knows that too. He went on to say, ‘This supports the principle that women are the centre of maternity care and they should have access to a wide range of birthing choices.’ I note, the comments from the member for Wentworth and his very heartfelt appreciation of the role that midwives played in the birth of his three children. He highlighted the role that midwives play in providing a choice for home birth. I commend him for his words. I appreciate them, as a midwife and on behalf of many midwives across the nation.
Importantly, this bill enables indemnity insurance for midwives working in ACCHOs. This is so important to ensure that culturally sensitive, enabling maternity care can be provided by midwives working with Aboriginal and Torres Strait Islander women in these settings, programs such as Birthing on Country. There is an urgency to redress unacceptable maternal and infant health outcomes for First Nations families in Australia, and Birthing on Country programs are a way forward to address this. The terms ‘birthing on country’ and ‘birthing on country models’ are generally not well understood. The Australian College of Midwives describes them as:
… a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies and their families which provides an appropriate transition to motherhood and parenting, and an integrated, holistic and culturally appropriate model of care for all.
Birthing on Country models can be described as maternity services that are designed, developed, delivered and evaluated with Aboriginal and Torres Strait Islander women and that encompass some or all of the following points: they are community based and governed; they provide for the inclusion of traditional practices; they involve connections with land and country; they incorporate a holistic definition of health; they value Aboriginal and Torres Strait Islanders as well as other ways of knowing and learning; they encompass risk assessment and service delivery; and they are culturally competent. Accordingly, Birthing on Country models can be incorporated in any setting, whether in a rural setting or in a metropolitan one.
I want to highlight this evening a study reported in the Lancet Global Health journal in May 2021. It reported on a multiagency partnership between two Aboriginal community controlled health services and the Mater Mothers public hospital, where they designed, implemented and evaluated a new Birthing in Our Community service. Between 1 January 2013 and 30 June 2019, 1,867 First Nations babies were born at the Mater Mothers public hospital, and women receiving the Birthing on Country service were more likely to attend five or more antenatal visits, more likely to have exclusive breastfeeding on discharge, less likely to have a baby born preterm, and their outcomes were seen as being highly satisfying for the women. This study has shown the clinical effectiveness of the Birthing in Our Community service. It was co-designed by stakeholders and underpinned by Birthing on Country principles. The widespread scale-up of this new service should be prioritised.
I want to pay tribute to Professor Sue Kildea and Professor Sue Kruske, who have an enormous canon of work in this space and have contributed a significant evidence base to underpin public maternity services policy for First Nations women. They are truly champions. Dedicated funding, knowledge translation and implementation science are needed now to ensure that all First Nations families can access Birthing on Country services that are adapted for their specific context. I want to congratulate the government on the $15 million budget line for Aboriginal and Torres Strait Islander mothers and babies grant opportunities for Indigenous led research that translates into culturally safe pregnancy, birth and postpartum care. This is really important.
There’s been a dramatic impact of COVID on women’s choice and control during pregnancy and childbirth. This bill could assist in increasing women’s access to the models of care that they really seek in order to feel safer and feel more in control of their births. Midwives are essential providers of public health care, and they contribute to enormously improved outcomes, especially for women who may not experience equitable access to maternity care. Midwives provide care, counselling, screening, vaccinations and sexual and reproductive health care in addition to pregnancy, birth and postnatal care.
There’s a lack of understanding about the impact and the value of midwifery practice on public health outcomes. The WHO’s State of the World’s Midwifery 2021 report calls for the expansion of midwifery led models of care to promote the health and wellbeing of the globe’s mothers and babies. This has never been more evident and important than during the COVID pandemic. To understand the impact of COVID on birthing women and their families, last year the Australian College of Midwives conducted a survey of women’s experiences of maternity care at the height of the COVID-19 pandemic. They wanted to explore and gain insight into women’s experiences as well as their challenges, uncertainties and fears. Almost 3,000 women completed that survey. Those respondents reported feeling isolated, alone and unsupported by the evolving changes of the pandemic, which led to anxiety, concern and distress. Wherever I meet them, midwives tell me that they have never before seen as many calls for help for mental health support for the women they care for. Many women expressed concern for their mental health in this survey. The results revealed that women were seeking alternative options to mainstream maternity care in an unprecedented way, and this included an exponential shift in looking for and asking for midwifery continuity-of-care services such as midwifery group practice, birthing centres and homebirth, either publicly provided or public-private provided.
Despite seeking other options, a large proportion of women indicated that they have not been able to find the kind of care they were really looking for. Alarmingly, three per cent of the more than 1,000 women who had reconsidered their care were considering birthing without any assistance at all at home—something known as free birth—and that’s really disturbing.
It’s imperative that the results of the survey and the views expressed by the women who contributed to it be considered in informing maternity policy in both the post-COVID-19 recovery phase and, importantly, a longer-term future. It’s now clear that many low-risk Australian women consider homebirth a safe option when attended by qualified clinicians. The evidence on whom homebirth is safe for is now very well-established. Large population based studies and subsequent systematic reviews and meta-analyses consistently demonstrate that planned homebirth is a safe option for women with low-risk pregnancies.
This evidence means that there are real opportunities for service choice expansion and cost reduction. However, there remain many barriers to achieving this. On 18 September 2019, when speaking on the Medical and Midwife Indemnity Legislation Amendment Bill 2019, I highlighted the need to include intrapartum care for homebirth in the indemnity cover for privately practising registered endorsed midwives. Unfortunately, this amendment has still not addressed this aspect of midwifery practice. Right now, section 284 of the national law has a transitional period of exemption until 31 December this year. My understanding is that this will be extended until 2023, but that does not solve the fundamental issue of no insurance for intrapartum care in a home setting when women wish to choose this—and what we know is that more women do wish to choose this.
Meeting the needs of women is a hallmark of a high-quality maternity system. A decade of Australian maternity service reviews have highlighted that women want increased access to models of care that include homebirth. The majority of women who access homebirth options do so through engaging a privately practising midwife—and that’s very expensive. Medicare is available for antenatal and postnatal care but not for the birth. The average out-of-pocket costs for women giving birth at home with a privately practising midwife is around $5,000. While there has been growth in publicly funded models across the country, with really reassuring evaluations, very few women can access this care.
This bill will certainly help optimise midwifery care, but there is much more policy tidying up to be done to ensure midwives can provide the care women want in the settings where they want it. For example, there is a practical safety problem when it comes to MBS item No. 82120 for the management of labour in a health service by a participating midwife. Anyone who has ever worked in a continuity-of-care model for birthing women—and I am someone who has—knows that the 12-hour rule is deeply problematic for any midwife who may be called to care for their client in labour when they have spent all day working in antenatal or postnatal care. The midwife must fulfil the 12 hours before transferring care to another participating midwife. This could easily be remedied by a change to the regulations around that item number. I’d be most pleased to work with the minister’s office to set that right.
In summary, this is a good bill and it addresses some deficiencies in the last one. But there is still a lot to be done to make sure that, as the minister himself highlighted, women truly have quality of care, control and choice.
A few more policy levers need to be pulled to make sure women have the safest, highest-quality care—and we know that, for low-risk women, that is continuity-of-care models. There is overwhelming evidence that continuity-of-care models, with midwives, lower the rate of stillbirth, lower the rate of birth interventions, increase the rate of breastfeeding and increase the woman and her family’s satisfaction with the care that they have. Midwifery group practice, birthing centres and homebirth can make that happen. So we need more publicly funded models of homebirth. We need to fix the Medicare issue with homebirth by having privately practising midwives. We need to continue to grow the birthing-on-country models in both urban and regional settings. And we need to include indemnity cover for intrapartum care in the home by a privately practising midwife.
I wish to acknowledge the extraordinary work of midwives as champions of public health, as guardians of safe birth, as guardians of women’s health and wellbeing and as the firm and loving hands that see a baby born into our nation and set them up for a high-quality healthy life into the future. I commend this bill to the House.