Motions

International Day of the Midwife

Ms DIGANCE (Elder) (12:19): I move:

That this house:

(a) actively recognises International Day of the Midwife celebrated annually on the 5th of May;

(b) acknowledges the importance of the focal theme of International Day of the Midwife in ongoing support of the global campaign highlighting the vital role of midwives;

(c) recognises the importance of visible investment and commitment in the advancement of the profession of midwifery as being fundamental to the progress of our future; and

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

Today I am delighted to rise and speak on the motion before the house to acknowledge the International Day of the Midwife 2016 on 5 May. I welcome to the gallery a vital and significant group of people to recognise and celebrate the fact that all present are connected by one single important theme, a thread that weaves the story of the very beginning of life and that starts the journey for all human beings on earth, a theme of new life, a story about our most precious resource—babies and mothers—to cherish, nurture and value (and there is a baby, thank you).

As humans we can design, construct, collect and own but to create and nurture, to give breath to new life, is empowering and life at its grandest. So today I welcome midwives and mothers, midwives of all levels of experience—students, teachers, lecturers, professors, eligible midwives, researchers, doctors of midwifery, masters of midwifery, retired midwives—and parents. I was hoping that my sister, a former midwife, and my mother would be here as well today, but sadly they have been delayed.

Between all of you, you represent consumers, the Australian College of Midwives (both South Australian and national), SAHMRI, the Women's and Children's Hospital, Flinders Medical Centre, Loxton Hospital, Child and Youth Health, Your Nursing Agency, Flinders University, UniSA and politics. Between all of us present today, by best guess (we made a rough calculation) we have probably brought into this world well over 1,000 babies. So well done.

This year's theme for the International Day of the Midwife 2016 is 'Women and Newborns: the Heart of Midwifery'. Around the world, daily midwives work hard to ensure that women and newborns receive the quality care they deserve. In doing so, families receive the care they deserve and society flourishes. I want to pause and reflect on the theme, in particular the words 'the heart', as they represent the sense that key to this theme is not only a physical presence but also symbolically an emotional, intellectual, and moral intelligence, the analogy being that at the centre of the profession of midwifery are our most important—mothers and babies.

Intrinsically, the meaning of midwifery is 'being with woman'. This meaning underpins the profession of midwifery, its philosophy, work, commitment, engagement and relationships. It is all-encompassing. It is who we are. It is our profession. Midwifery is founded on deep respect, the unique value of women, the value of wonder and intimacy, on all the processes of nurturing and of bringing into this world new life and, with it, associated expectations, dreams and hopes for all humankind. A midwife is a professional of high educational status, a practitioner, a carer, an academic, a researcher, an authority, a keeper of the human social bank of health and advancement based on the knowing that continuum of care is critical.

Proudly, South Australia was one of the first states to introduce a three-year undergraduate midwifery degree, allowing students to qualify as a registered midwife in their own right, and making the midwifery workforce a truly professional workforce of highly trained and specialised practitioners. In South Australia there is an expectant anticipation in the midwifery profession as midwifery-led models of care present opportunities and synergies with the current directions of the state's Transforming Health plan.

As many of you here today know, I am a strong advocate on behalf our profession to ensure these possibilities are vigorously explored with a view to facilitate provision of access to safe maternity care choices for every woman, as outlined by the National Maternity Services Plan. South Australian midwives work passionately and professionally, championing progress in the best interests of women, babies, fathers, families and communities.

An ever-growing body of research clearly demonstrates, by hard data, the benefits of midwifery-led care; it is indisputably the best and most effective care model for pregnant women of all-risk profile. Australian research shows that women receiving one-to-one midwifery care have 22 per cent less risk of caesarean birth, are 13 per cent more likely to have a normal vaginal delivery, that there is a 12 per cent reduction in epidural anaesthetic use, and that their babies are 37 per cent less likely to be admitted to a special care or neonatal intensive care nursery for treatment. These statistics are of exceptional excellence, and cannot and must not be ignored.

In comparison, research has shown that low-risk women having their first baby in a private hospital compared to that of a public hospital sees a doubling and, in fact, a tripling of the rate of induction, instrumental birth, caesarean section, epidural and episiotomy. Not only do these interventions cause traumas to mothers and babies, but they also unnecessarily increase healthcare costs. The secondary findings demonstrate a 33 per cent increase in the welcome likelihood of natural onset of labour and associated breastfeeding that will continue into the first six months of life.

Also based on research, the overall median cost of birth per woman in Australia is around $600 less under the model of midwifery-led care as opposed to standard hospital care. In addition and of note is the duration of hospital bed stay rates, which is lower with midwifery care. Antenatal hospital admission and bed stay for midwifery-led care sees days stays of only up to 12 days compared to standard hospital care of anything up to 40 days. This demonstrates not only a financial saving but also a social gain, as families are reunited more quickly.

The popular and highly utilised midwifery group practices are examples of existing models supported by this research and are deserving of expansion. The education and expertise of the eligible midwife, whose equivalent in general nursing is broadly that of the nurse practitioner, would if utilised to their full potential provide efficiency savings in the health system while ensuring a high level of practice.

The option to explore the extension of the role of the eligible midwife, a highly credentialled professional, could be extended to encompass admitting rights to public hospitals, thus ensuring the continuity of care with corresponding cost efficiencies to the state. Queensland already leads successfully in this model of care, and we hope to follow. Research demonstrates the importance that continuity of care has in contributing to good health outcomes.

I am sure that as midwives and mothers we have always intuitively known what the emerging research is now articulating in relation to the negative effects of trauma during childbirth and unnecessary intervention. Elizabeth Mary Skinner's recent research addresses maternal injuries, and in particular insights into the use of forceps. Her research indicates that the injuries from childbirth are not just physical but also psychological.

So far, the women who have been surveyed and experienced these injuries are asking questions, and they are all the same questions: why were we not told and why were we left with such terrible injuries, injuries that have ongoing debilitating lifelong consequences? They include injuries such as incontinence, prolapses and being unable to stand for long periods due to all these injuries and the associated pain. The psychological injuries Elizabeth cites in her research can be likened to post-traumatic stress disorder as opposed to postnatal depression.

This builds on the evidence that already exists from other studies that traumatic birth experiences are associated with psychological impairments. Feeling safe is such an important element during pregnancy when in labour and also postnatally. It is not just one person's health: it is two—a mother and a baby. It may actually be three and sometimes more. This can weigh heavily on the minds of the expectant mothers and fathers and parents. As one new mother said:

With a midwife, I knew I had a greater chance of having a natural birth without surgery or medication—and that if I did need some kind of intervention, that it was truly needed. I felt safe, guided in the hands of a professional but someone caring as well—someone who really listened, someone who was really [there] with me every step of the way.

I wish to also acknowledge at this point that midwifery care alone may not be appropriate for everyone. We all know that there are some very complex health issues and complex pregnancies, and that collaboration and cooperation between midwife, doctor and hospital can be essential for these particular cases. At the end of the day, and rightly so, what we are after is the best health outcomes possible.

So I appeal to you all in your role as professional midwives: be vigilant, be confident, be proud of our profession and continually advocate a behalf of our profession. What you do, what you achieve, what wish to achieve, what you offer, how you practice, and all that encompasses being a midwife is limitless—do not confine it.

Use language befitting a proud and important profession. The use of language, as we know, is so powerful that it affects outcomes and actions. Just on Monday, for instance, I was appalled to see a little teaser in The Advertiser alerting readers to the fact that, in the SA Weekend section coming up this weekend, there would be an article. The heading was: 'Is breastfeeding becoming a cult?' I read it a couple of times. Was this ignorance, bullying, harassment, gender disrespect or plain stupidity? The use of the word 'cult'?

I am here to tell everyone (and it is on the record) that breastfeeding is not a cult, it is an essential to baby and maternal wellbeing. It has well-recognised maternal, infant and public health benefits, and should be supported, encouraged and embraced. The World Health Organisation recommends exclusive breastfeeding only for infants up to the age of six months and continuation up to two years of age, complemented by solid foods where possible. This advice is based on evidence and is a basic human right. Breastfeeding can be difficult enough as it is without social stigma being added to the mix.

I also urge you all to ensure that the 90,000 or so new mothers who benefit from a vital breastfeeding helpline do not miss out as a result of the current federal government funding cutbacks. The federal government, in its wisdom, is only going to fund the Australian Breastfeeding Association's 24-hour telephone counselling service until June this year. The association says there is no process for it to re-apply for the $1 million grant it relies on to survive. Make this a campaign and let those in Canberra know that this is not on.

I will end on a bright note, and rightly so, because we are here to celebrate and recognise. I highlight the rise and rise of the profession. Excitingly and proudly for all South Australians, we see that UniSA's nursing and midwifery faculty now ranks in the world top 50 in the 2016 QS subject rankings, which is an annual publication of university world rankings. Congratulations.

I am really honoured to announce here today a very special, innovative and groundbreaking program: UniSA has plans to open the doors of the state's very first university midwifery-based service. It will be a pregnancy and parenting hub, with eligible midwives providing exceptional care opportunities for both student midwives and mothers-to-be alike. It will ensure high-quality antenatal and postnatal maternity care, and is aiming to be opened in June this year. Congratulations to all involved, I know it has been a long road, and in particular to Dr Lois McKellar. Well done. It is groundbreaking and really exciting.

With this great milestone announcement, I pay tribute to all of you here today in the gallery. Congratulations to all who practice in this very privileged area of expertise, the profession of midwifery, and thank you from all of us here in the house. We have many in our cohort who have babies: we have parents, new parents, grandparents and parents-to-be. Thank you to all of you for all you do and your commitment to South Australia and South Australian families in the role you play in the care and advancement of the welfare of this state. Thank you from all of us here in the house of parliament in South Australia.

Dr McFETRIDGE (Morphett) (12:33): The 27^th of January 1952 is not that long ago in reality. It was snowing very heavily in Leicester, England on that morning. My father had brought the bed down from upstairs and put it in the front room. He had been out the back and dug up some bricks, because the midwife wanted the bed higher. She suspected that I was going to be a rhesus baby, so she sent dad off to get the doctors.

Dad's only mode of transport (it was snowing heavily) was a pushbike. He reminded me a number of times that he fell off his pushbike in the snow and was quite battered and bruised by the time he got back with the doctor. However, at 8.30 in the morning on 27 January I was born 7lb 2oz, a healthy boy. The midwife was there and made sure it all happened.

Can I just put on the record that I would like to thank my older brother Ian, who was 11 pounds two ounces, and the midwife delivered him as well. I have to thank the profession of midwifery. I do not know the name of the midwife who assisted my mother with my birth, but so many of us are here today and are fit and healthy because of the work that midwives have done.

In Australia, according to the AHPRA website, there are 370,303 nurses and midwives registered in Australia and 89.5 per cent of those are females. The midwife who delivered me, from what my mother has told me, was a very experienced midwife. As a veterinarian, you know that there is a lot of science in what we are dealing with in pregnancy, gestation and birth, and the difficulties associated with obstetrics.

But it is not all science. It is experience and it is know-how. It is knowing what is right, what is wrong, and having that third sense. I know that is something that we have in abundance in Australia with our midwives. We know that they are a vital part of the obstetrics and gynaecology section of the medical profession today, and it is a profession. The announcement today about the increased opportunities for tertiary education for midwives is a great one.

The empathy, the professionalism that we have in our midwives in South Australia is something that I think we should all be very proud of. I know there are members on both sides who have wives or relatives who are midwives. My aunt was a midwife at the Queen Victoria Hospital many years ago. The need to make sure that we do value the input from our midwives, and nurses and doctors, the whole medical profession, but today we are celebrating the International Day of the Midwife on 5 May, is very important for us to do in this place.

The member for Elder has highlighted a number of points in her speech about the debt we owe midwives. I know that on this side of the house we all support the motion very strongly. I will say one political thing though: I wonder if Bill Shorten is going to support the National Breastfeeding Hotline. I hope he does. I think we should because they are very important things to do. Giving mothers information is something that is very important. That information should be good information, it should be based on experience, based on training and based on professional knowledge.

Who are the best placed people to do that? Our midwives. So, why not continue funding those programs? I think that is something the federal government should do. I think Bill Shorten should come out and say to do that, so that we are supporting not only the midwives in being able to deliver what they want to do, but also the mothers. As a father, and a grandfather, it is a learning experience, it is a huge learning experience, and you can only learn if that information is available.

I will end my short contribution there. The member for Elder has put a fair bit on the record. I congratulate the midwives in South Australia and I acknowledge their presence today in the gallery. Some of them are present here today, others are out there doing their job, they are delivering babies as we speak and making South Australia a wonderful place to live because they are bringing healthy babies into this state.

The good thing about being in this place is being able to do this sort of thing. While some people think we should be arguing about other things, this is a very important issue for us to acknowledge in this place. So, to the ladies and any gentlemen who are in the gallery today, congratulations. Thank you for what you are doing. You can be assured the Liberal Party of South Australia is supporting you very strongly.

The DEPUTY SPEAKER: Member for Fisher. We are allowing a little bit of latitude today.

Ms COOK (Fisher) (12:38): Don't stop them clapping now.

The DEPUTY SPEAKER: No, they can clap but not make noise, perhaps.

Ms COOK: Thank you, Madam Deputy Speaker. I rise today to make a very small contribution in support of the member for Elder's motion supporting midwives this year (2016), and very proudly. This is my second contribution as there was a similar motion last year. Midwifery is a science but, most importantly, it is an art. It is the art of understanding, adapting and supporting women at various stages through their lifespan, and also children.

I am not a midwife, I am a registered nurse. I had every intention of becoming a midwife when I was in the School of Nursing at the Queen Elizabeth Hospital but, as you all know, sometimes things happen that take you down a different pathway. I have had the absolute pleasure of working with many professional midwives throughout my career, at one stage in a private hospital many moons ago when life was a little different in practice. I was what you would probably call a midwifery 'wingman' (or 'wingwoman') so to speak.

When the heat is on and when the women are waddling in the front door and the numbers of women far outweigh the numbers of midwives because it is Christmas morning, things have to be done very quickly. You need to become very quick and clever at adapting. I have had the great pleasure of having very close and deep relationships with many midwives over the course of my nursing career and have shared some of the happiest and some of the most challenging times in my life.

My first child was a challenge during delivery, shall we say. I was quite unwell and consequently ended up having an emergency section, but that was after having many hours of very comforting but firm words. I do not know if you are up there, but it was Fran Schmidt, who many of you would know, and I have never forgotten her. I know she is still around the place. She delivered my son with assistance in theatre by a surgeon and obstetrician, and I will never forget that calming influence she had. I still have not looked her in the face and apologised for the scratches on her hands which occurred during the course of that afternoon.

The National Breastfeeding Helpline, and any breastfeeding support, must and will be supported. I know that Kate Ellis, a shadow minister in the federal parliament, has put on record their support for the funding model. I attended a forum last night in which Kate Ellis, Amanda Rishworth and Penny Wong took part. With those three women having welcomed babies into their world again in the last year and a half, and with the feeding problems that come with it, I do not think our leader Mr Shorten will have any choice but to support continuing that model.

Change is an extremely challenging thing in anything, but in health care it is very difficult sometimes when you are inside that system to see the benefits of a change in outcome. However, I watched within the healthcare system the wonderful leadership and progressive movement of midwives towards their independent profession, and I congratulate those of you within the gallery today who were part of that. I know some of you were part of that transition. Thank you for that because it has certainly improved the care that is delivered within our community to women and children. We are grateful for that.

Thank you for your enduring commitment to our community to women and children which in turn improves full lives within the community to everybody. I promise you that while the member for Elder and I are in this place you have an absolute direct voice to government. I thank you for your attendance. I congratulate you on the work you do and commend the motion.

Ms DIGANCE (Elder) (12:43): I would like to thank those who have contributed to the debate today, my friend in the opposition the member for Morphett and also the member for Fisher. Thank you for your support. Once again, I congratulate all the wonderful work you do as midwives. It is an amazing profession. We are to be proud of what we do and what you all do. I commend the motion to the house.

Motion carried.