Motions

International Day of the Midwife

Ms DIGANCE (Elder) (11:20): I move:

That this house—

(a) recognises International Day of the Midwife on 5 May 2015;

(b) acknowledges the focus of this year’s theme ‘Midwives: for a better tomorrow’, which is part of an ongoing campaign highlighting the important role of midwives;

(c) recognises the critical role of UN millennium development goals 4 and 5 addressing infant and maternal mortality; and

(d) congratulates all South Australian midwives for their promotion of woman-centred care, their dedication and professionalism to the health and wellbeing of women and babies, and indeed families.

I speak to the motion recognising International Day of the Midwife which this year will be on 5 May and which is celebrated annually. As a midwife of many years' practice in policy, teaching and as a clinician in hospitals and community settings, I have been privileged to work with and experience the spectrum of continuum of care of women, babies and their families. I am pleased today to have the opportunity in my role as a politician to pay tribute to my colleagues and peers who have joined me here in the chamber.

Today in the Speaker's gallery are my guests—many passionate, professional and experienced midwives from Child and Youth Health, Flinders Medical Centre, the Lyell McEwin, Mount Barker hospital, Women's and Children's Hospital, UniSA, Flinders University, Australian College of Midwives and the Australian Nursing and Midwifery Federation as well as some eligible midwives. Welcome. Today, I am your voice in parliament with your message, and I thank Liz Newnham for her input into my speech today.

Annually, 5 May is International Day of the Midwife, a day to celebrate the work that midwives do around the world. This year the theme is 'Midwives: for a better tomorrow', as increasingly there is global recognition of the importance of midwifery care for all pregnant women. It is a day for the rest of the community to stop and say thank you and appreciate the important work you all do.

Midwife simply means 'with woman'. The highly-skilled, professional and intimate practice of midwifery is just that, with women central to all you practice. Midwifery care during pregnancy and birth is recognised internationally as key in reducing maternal and neonatal mortality and improving health outcomes.

In 2010, the World Health Organisation developed a set of global health outcomes known as the millennium development goals, with targets of achievement due for revision this year. Maternity features in these goals at Nos 5, 4 and 3, being to improve maternal health, reduce child mortality, promote gender equality and empower women, respectively. This has highlighted the crucial importance of the role of the midwife in improving maternal outcomes. Indeed, it also highlights the importance of maternal outcomes for the health of societies.

In 2011, the United Nations Population Fund with the International Confederation of Midwives and the World Health Organisation collaborated to produce a report titled, 'The state of the world's midwifery'. This inaugural document looked at the global presence, influence and effects of midwifery care. Countries such as Afghanistan, Bangladesh and Sierra Leone were identified as having little or no organised midwifery training, with women having very little or no access to midwifery care.

This report highlighted the importance of a visible midwifery profession to advance the health of nations, with dedicated government funding and accredited education systems. In support of this view, the report states:

In countries all over the world, retrospective studies attest that quality midwifery services are a well-documented component of success in saving the lives of women and newborns as well as promoting their health. A strong midwifery workforce brings indirect benefits too, contributing to the advancement of gender equality and women's rights and empowering women to take care of themselves, their families, their communities and their nations.

The report also found that, in many countries, midwives are not able to work to their full scope of practice due to lack of relevant resources or resistance by the medical profession and policymakers.

In Western countries, the issue of midwives working to their full scope of practice varies. In some European countries, midwives have a long history of autonomous practice in collaboration with their medical peers, which occurs in a culture of mutual respect, resulting in low maternal and neonatal mortality rates.

In Australia, the midwifery profession has historically been controlled by medical models and its scope of practice significantly reduced and medicalised. The peak professional body representing midwives in Australia, known as the Australian College of Midwives, has worked hard (both nationally and internationally) with organisations such as the International Confederation of Midwives and the World Health Organisation to positively influence policy in this country.

As identified in the National Maternity Services Plan of 2011, it is time to give Australian midwives the occupational autonomy and respect—

Members interjecting:

The DEPUTY SPEAKER: If I could call members to order; there is a lot of noise on my left. Thank you.

Ms DIGANCE: —that is so highly significant to maternal health and to locate birthing services where women live. It has been identified that midwives who are educated and regulated to international standards can provide a significant 87 per cent of the essential care needed for women and their babies. Investing in midwives is definitely a best buy in public health outcomes, and it is estimated that there is a 16-fold return in health savings, including reduction of caesarean section rates. Investing in midwives also frees up medical personnel to attend to the healthcare needs of those who most need it.

There is a story of a doctor discussing an Australian research report that showed a decrease in caesarean section rates using midwifery-care models. The doctor is known to have said, 'If midwifery care were a pill, all women would be getting it.' It is time to move beyond professional boundary staking—a proportion of which is financially based—and implement this essential service for all women for the good of their care and the care of their babies and their families.

An increasing concern in developed countries like Australia is the high intervention rates during labour and delivery—a result of the overmedicalisation of an essentially normal physiological function. While midwives would be the first to recognise the importance of having emergency measures in place, the midwifery philosophy and models of care that emphasise 'keeping birth normal' are known to reduce intervention rates. There is now clear demonstrated evidence that shows the importance of midwifery-care models and its associated better-health outcomes with its reduced use of what, over time, has become routine intervention. Evidence also demonstrates a more efficient use of resources.

Overmedicalisation is emphasised by the experience in Brazil where, recently, there has been heavy investment in midwifery-led birthing units as a focus strategy. The strategy is in response to their exorbitant caesarean section rate, which is at a high 52 per cent across sectors, and increasing, unbelievably, by 300 per cent in private sectors.

A high rate of Australian women (being 97 per cent) give birth in hospital labour wards. Notably, women receiving private obstetric care are at an even greater risk of medical intervention. Case in point are low-risk first-time mothers. Statistics of birth intervention of this cohort show disturbing rates of intervention with private hospital-care percentages being higher than that of public care. Alarmingly, in the private system, it has been found that there is nearly triple the rate of induction of labour and a twofold increase in the use of epidurals. There has also been a significant increase in instrumental birth, caesarean section and episiotomy. These worrying statistics should be a signal for change—they highlight the need for change.

Labour and delivery is, in the main, a normal, physiological process that does not require intervention. A UK study has shown that with midwifery-led births, women are at a lower risk of intervention with higher proportions of normal births, lower caesarean-section rates and no increase in adverse outcomes. It is recognised, though, that first-time mothers may have a higher transfer rate to a hospital, and this is manageable.

Birth centres and homebirth models need to be integrated into surrounding maternity services in an atmosphere of mutually-supportive teamwork between midwifery and obstetric services with timely emergency referral systems in place. Although there is a lot of importance placed on pregnancy and birth, postnatal care is very often overlooked. Postnatal care is important for attachment, bonding and fundamental development. Midwifery models of care are more able to provide the much-needed support, encouragement and information so necessary to families in this time of transition.

In Australia, place of birth remains a concerning problem. Indigenous women in many remote areas are required to leave country in order to birth their babies. This poses a significant risk to spiritual health, as birthing on country is an important connection to ancestry, not to mention separation of the woman from the extended family. Maternal and neonatal morbidity and mortality rates remain strikingly high in both urban and rural Australian Aboriginal populations, and this must be addressed as a matter of urgency. The training of Indigenous midwives must be a priority of governments and could be encouraged by the provision of more scholarships for this purpose.

The recent guidelines from the National Institute of Clinical Excellence in the UK recommend that women with low risk pregnancies be counselled so that they are aware of the higher risk of intervention in obstetric units, including public labour wards. They should also be advised that birth centre or home birth settings result in higher rates of normal birth rates with no increased risk of adverse outcome.

The current South Australian Transforming Health initiative is the perfect opportunity to expand and further develop midwifery services. This opportunity exists on a number of fronts being, firstly, incentivising eligible midwifery and ensuring that local health networks work with eligible midwives to facilitate admitting rights and, secondly, to increase publicly funded birth centre and home birth models. Ideally, all women in South Australia should have access to a known midwife in a continuity model of care. Women who present with or develop complication could be referred to obstetric and medical specialists as required with the midwives still providing the necessary antenatal, labour and postnatal care. This is aptly acknowledged by the mantra, 'All women need a midwife, some need a doctor, too.'

To achieve the Transforming Health ideal of 'Best care. First time. Every time.' in the maternity sector, midwifery care should be implemented as the primary maternity care model. Transforming Health values are centred on six quality principles: patient-centred, safe, effective, accessible, efficient, and equitable. All these principles run in parallel to those values of midwifery care. To this end it is promising to see that midwifery models of care are being prioritised in the next steps of the Transforming Health agenda. However, the infrastructure must be in place and cultural change supported for this to come to fruition.

Transforming Health also identifies that health needs have changed and that the historical purpose of hospitals does not fit with our community needs of today. Technology has advanced and changed as now we can monitor our health and record and communicate electronically without being in the same location as our treating professionals. We have improved clinical practice and recovery time frames. It is also recognised that there are too many procedures performed with an unnecessary and unsustainable expense. It is widely known that the health budget is under considerable strain and cannot be supported on the trajectory as it currently stands.

True midwifery driven care and practice can arrest and address many issues of the challenges identified in the Transforming Health process. Midwives are ready to step up, ready to embrace the challenges, ready with solutions, ready to deliver midwifery driven care. Midwifery is a profession in its own right. Medicare recognises the eligible midwife as a highly educated, experienced and practised professional. In a recent edition of the prestigious and well known medical journal The Lancet, the authors claim:

Midwifery is a vital solution to the challenges of providing high-quality maternal and newborn care for all women and newborn infants, in all countries.

This is a significant progression, admission and support of a concept whose time is now.

In closing, I thank all midwives in their many roles and capacities who every day in South Australia make our state a better place with their professional care of women, babies and families. I invite us all to celebrate the importance of midwives on 5 May, and invite politicians, policy makers, obstetricians, health managers, fellow midwives and the community to work together to help provide South Australian women with midwives for a better tomorrow.

Mr WILLIAMS (MacKillop) (11:35): It is with a great deal of pleasure that I rise to support this motion. I want to talk about a number of aspects of midwifery. I have a daughter-in-law who is a practising midwife in a rural community. The member has just talked about Transforming Health. My reading of the Transforming Health document is that it is much more about controlling the health budget than delivering high-quality service.

I will use the example of what has happened in my electorate: the Keith community and the Keith hospital are in my electorate, and we saw over recent years what budgets and bean counters did to that particular community and their hospital; they caused a huge amount of anxiety. Closer to where I live, in the southern part of my electorate at Millicent, we have seen the birthing unit at the Millicent hospital close down.

The member talked about the problems faced by Aboriginal communities. I can assure her that most country communities face not dissimilar problems, where young mothers have to travel long distances to a birthing unit, often hours away from their home, putting untold strain on their families. This is common practice in country communities and it is unnecessary.

At the Millicent hospital, before the birthing unit was closed down, every expectant mother who approached the hospital or the local medical clinic with the birth of their first child was automatically told that they would have to go to the Mount Gambier Hospital for the birth of that child, just because it was their first child. It was deemed by our Department for Health that, just because it is the first child, it is automatically considered a complicated birth.

Mr Pengilly: Ridiculous.

Mr WILLIAMS: It is a nonsense. I have another personal experience, in that my youngest daughter gave birth to her first child on 8 February this year, and that birth occurred in New Zealand. In New Zealand—and I have talked on this matter previously in the house—the delivery of obstetrics treatment is quite different from here in Australia. Indeed, it is what the member has been talking about. Midwives in New Zealand are at the forefront, and it is only when it is confirmed that an expectant mother may present some complication that there is a referral to a specialist doctor. Otherwise, the totality of the expectant mother's birthing experience is handled by a midwife.

That is the circumstance that my daughter has just been through. When she became aware that she was pregnant, she visited her local GP, who certainly confirmed the pregnancy and explained to her that she needed to contact the midwife. The GP explained to her where she could get a list of midwives who were available in the local community. She went through that process; she had regular visits to a midwife, whereas here in Australia she would have had regular visits to her obstetrics-trained GP or a specialist obstetrician.

At the appropriate time, my daughter contacted the midwife to say that she had gone into labour. The midwife gave her further advice over the phone and again, at the appropriate time, she got herself to the local hospital, where the midwife caught up with her, and they went through the rest of the process.

I can say with some confidence, because my daughter-in-law is principally involved in postnatal care, that the postnatal care that has been reported to me by my daughter in New Zealand is much more intense than what happens here in Australia. The midwife visits a minimum of once a week, depending on need, for a minimum of six weeks. If there is any further care, attention or help needed, that is also provided.

The previous speaker spoke extensively about intervention, and it is no revelation that intervention is rife amongst obstetric service provision in Australia. I think we have the highest intervention rate of any country in the world and, again, it is unnecessary. Not only is it unnecessary but it is damn costly. I come back to Transforming Health: the reason I think it has more to do with trying to manage the budget than providing high-quality care and service is that there does not seem to be any move within Transforming Health to do things better.

I am convinced that the scenario my daughter recently went through in New Zealand is, for a whole host of reasons, better than she would have experienced if she had been in Australia. I am convinced of that. I know that the procedures and the processes involved in the birth of her son cost the health system in New Zealand only a fraction of what they would have cost the health system if she had had that birth in Australia.

For that reason alone, the Transforming Health process should be looking at these sorts of examples. It should be bringing best practice from places like New Zealand, where the outcomes are just as good as we experience here and where the cost, I would argue, is only a fraction thereof. If the Minister for Health were fair dinkum about best care first time, every time, he would be doing more than just having the accountants run through the books of his department. He would be getting experts in a range of fields—in this case, in obstetrics—from those places where they do it differently and, I would argue, do it better.

There is no doubt in my mind that midwives perform a fantastic duty and service to our community. They do it with great professionalism and they do it very well. We have allowed probably the strongest union in Australia, the AMA, to demand that we have specialist doctors undertake duties which are just unnecessary. It is the power of the medical union that is driving decisions about the way we deliver medical services. It is not about the outcomes, it is not about the treatment and the service received by the individuals: it is about money, at the end of the day. That is the problem we have and it is a problem I think the current minister, and the current government, in his Transforming Health project has failed to understand and certainly failed to do anything about.

I support the motion as it is brought to the house, and I support the sentiments of the member and what she said about it. I just wish that her government would do more than pay lip service and indeed recognise how much better our system could be if we utilised midwives to their full potential in South Australia. I commend the motion to the house.

Ms COOK (Fisher) (11:44): I rise to speak today in support of the member for Elder's motion recognising the work of our midwives. It is truly an honour to be able to stand in this place and raise awareness of the incredible and inspiring work, which is so physically and emotionally gruelling, done by thousands of practising midwife professionals around the world. Welcome to my nursing and midwifery colleagues in the gallery today. I have shared much joy and also heartache with several of you. You are wonderful professionals, and I am very proud to call you friends and so privileged to support your work.

This is not an easy subject to speak on. The journey of motherhood is not always easy. Since becoming a parent so easily in my early 20s, I experienced many losses and had the frustration of 13 cycles of IVF until getting it right, so to speak. All throughout this journey I have been supported by the most incredible people, the midwives.

My story though is not unique. The journey was not impossible and the final chapters have been very happy. This is not always the case with parenting journeys. Midwives are the keepers of secrets and bearers of burden. They absorb the emotion and pain like sponges, with little complaint, and continue to display kindness and care against the odds. When I asked one of my friends about the ups and downs in the day of a midwife she had a few thoughts about how to balance this, and she did two things. Firstly, she shared her deeply personal story, which I am going to share with you today:

Who am I?

I am a midwife.

I work with women, I am one of the first people they tell they are pregnant, I am one of the first to feel their immense joy and excitement, I am privileged to be let into their lives and share this news.

I share their despair when their pregnancy is unwanted and they need to work through the detour in their life plan.

I get to see women grow, not only the baby growing inside them, the family grows, and relationships grow stronger and develop.

It is a privilege getting into my car when there are no cars on the road, everyone is asleep. I share in the journey of labour and birth with this woman, the excitement, the despair, the tears, the joy…I gave birth to a beautiful baby girl in 2003.

In 2006 we were extremely excited to be expecting our second child. But it didn't feel 'right'.

Once again I was completely supported by midwives, they reassured me, supported our family, they shared when I felt movements, they got excited by my scans, but this baby was not meant to come…When I birthed my baby halfway through my pregnancy, a midwife was the person who gently cradled our baby, who gave her to us, who shared this treasured time with us but also enabled our family to grow, love and grieve.

Our third daughter was born in 2007, I was cared for by a midwife, who left her home at 11 o'clock at night in the middle of winter, to come and be with me and my family. I was privileged to have her with us, I appreciated the sacrifices she made for us…There are times when I miss important days in my life, I've worked Xmas days, I missed one of my children's first steps, there are times when I make school lunches at 2am then kiss my children goodbye while they are fast asleep and leave a 'hope you have a great day at school' note, but I get to go and share amazing things with amazing people.

This amazing and very brave midwife then pointed out a short clip on the internet, which I watched about half a dozen times last night. The clip is played to the very deep music of Cold Play's Yellow. It is very emotional and it is a teaching tool for student midwives and also the public. It helps to show the amazing contrasts of this wonderful profession, where 'Being a midwife is not just a job, it is a lifestyle.' The video goes on to urge the watcher to check their work/life balance, to look after themselves, to have 'me' time. I am possibly not the best person to preach this, but anyway, please do as I say, not as I do.

As a government, we must look after these clinicians who bring life to our community. We need to do this by ensuring safe work practices and by listening to them. The ICM slogan is that midwives save lives. Women and their babies in South Australia need to have equitable access not only to qualified midwives but to a range of models of care that support safe and effective options for women that meet their needs when they need it.

It is not right that a woman living 12 kilometres from another woman has different access to midwifery services, depending on their birthing journey. A key example of this is a woman who needs a caesarean section in her first birth but is not able to have what lay people would know as a normal birth cared for by a midwife for the next in hospital A, but this normal birth may be offered in hospital B, and just because she lives another 12 kilometres away. Even further away she has to be separated from her family for an extended period of time for fear of her going into normal labour. This is a terrible burden to our rural and metropolitan families. We are obliged to ensure that all women have access to continuity of care models regardless of risk and geography.

Transforming Health actually does use clinical experts. The needs of this are ongoing. Transforming Health needs to become the norm, an ongoing process with health care and all challenges must be considered. My friends, my colleagues, I thank you and I commend this motion to the house.

The DEPUTY SPEAKER: Member for Colton.

The Hon. P. CAICA (Colton) (11:49): Thank you very much, Deputy Speaker, and I will prove to the house that you do not have to use your whole 10 minutes, which was also the case with my very good friend the member for Fisher. Firstly, I want to commend the member for Elder for bringing this motion to the house. I have had little experience with midwives, save except for the birth of my two children, and I can tell you right now that there is no doubt in my mind that the midwives that we had would have been able to perform the whole function during that birthing rite, instead of seeing—and I am not being disrespectful to those experts in the area of medical birthing—the obstetricians, how do you say it, who came in on the gravy train at the end of the process when all the hard work was done.

There is no doubt that even with our first child, James, who required a ventouse and who came out looking like a cone head, and I was very frightened at that stage, but it was not the doctor who calmed me down, it was the midwife who was still there, saying, 'Everything will be alright. It will flatten itself out pretty quickly,' and it did within a few minutes. Notwithstanding that, I just saw a woman out in the chamber, Kim, the member for Goyder's personal assistant, who has just had her second child—

Mr Griffiths: Staffer.

The Hon. P. CAICA: Staffer; a very nice person. She said, 'That was easy,' because I had told her, 'I think the second one is generally easy.' Not that I would know because I do not think there is anything ever like an easy birth from the two that I have witnessed, but she said that it was easy. In my experience there is no such thing as an easy birth.

The point I am trying to make and I do not want to be too long winded is that, in my view, there is no doubt that the midwives were not only the first port of call but could have continued through that whole process and delivered the baby with the skills that they have. I commend the role and the function that midwives play in the birthing process in South Australia and long may it continue. Not just long may it continue, but I hope it becomes more entrenched in the process.

I do want to recognise that the member for MacKillop said some good things in his contribution in recognising the role of midwives, and the example in New Zealand, but a significant majority of it was codswallop. He should be brought to task on that particular matter because, whilst the opposition wants to politicise and make hay, if you like, out of Transforming Health, the very basis of the Transforming Health process is, in my view, to adopt the midwifery model and to embed that into Transforming Health, and not just in the midwifery model but in all aspects of what nurses can provide that is currently being provided by doctors.

The member for MacKillop would be better off getting a better understanding of what is the thrust and the genesis behind Transforming Health—and I know we are in a political environment—instead of attempting to politicise a process and he will come to the realisation that those things that he wishes would occur under Transforming Health are going to occur. So open up your eyes, clean out your ears, and become a little bit more positive about this particular process.

Mr Gardner: You are the only one making this personal.

The Hon. P. CAICA: No, I'm—

The DEPUTY SPEAKER: Order! I bring the member for Colton back to finish his remarks.

The Hon. P. CAICA: I said I would be very brief and I am going to be, Madam Deputy Speaker, but I think the record needs to be corrected when statements that have been made are incorrect, and that is what I am doing. I commend the motion and I thank the midwives for all they do in South Australia. I urge them to continue to play their role in ensuring that Transforming Health achieves what I think it is going to achieve with respect to the role of midwives in South Australia. Thank you for your outstanding work.

Ms DIGANCE (Elder) (11:54): I would like to thank the member for Fisher for her contribution. I would also like to thank the member for Colton for his wise words in correcting the record. I would like to thank the member for MacKillop, and I will take his remarks as supportive of the profession of midwives. Today is not a one-off conversation and representation; it is a beginning of more dialogue to come, of a continued dialogue, and I take this opportunity once again to acknowledge such a wonderful profession, the profession of midwifery, and I wish all of you well on 5 May.

Motion carried.