International Day of the Midwife

Ms DIGANCE (Elder) (12:02): I move:

That this house recognise—

(a) the key role of professional midwives in provision of accessible, affordable midwifery-led care for women and babies;

(b) the evidence that demonstrates midwifery-led care provided by educated, experienced, professional midwives promotes improved quality of care and wellbeing of women and babies;

(c) that the role of the midwife is key to forming positive foundations critical to the first years of a child's life; and

(d) that on 5 May, as we recognise International Day of the Midwife, we pay tribute and acknowledge the valued and valuable work of all midwives, and their vital role as we all commit to champion and promote this pivotal model of care.

To say I am honoured is an understatement, as I welcome today to Parliament House around 60 midwives and mothers with their babies. Welcome to all of you. Why are we all here today? You are here and I am here because we know the value of midwifery-led care and the value of the profession of midwifery. You are here to pledge your commitment to this profession that is key to building healthy communities. You are here to demonstrate that every woman deserves choice, the right to midwifery-led care, with its validated health and wellbeing outcomes.

Annually, since I have been the member for Elder, we have gathered in this house to recognise and champion the profession of midwifery and its critical importance to our society's development and progress. To reaffirm and reinforce a cohort of passionate, dedicated and highly educated people with university degrees, highly experienced professionals, as many of you here are, is incredible. I am a midwife, I am also a registered nurse, and I have worked for a long time with at-risk families. I have taught midwives at the University of South Australia and more recently I was appointed adjunct associate professor with the Faculty of Medicine, Nursing and Health Sciences at Flinders University.

This house knows my commitment to the profession of midwifery, as every year I invite my fellow parliamentarians to give real recognition to your value. Present today is a very rich mix of clinicians, professors, associate professors, doctors, ANMF leaders, chief executives, university academics, students, mothers and a few babies—which is great—and also some of my fellow midwifery students from The Queen Elizabeth Hospital days. Collectively, I estimate that here today we would have well over 1,000 years of experience.

All of you here are representative of what is of critical importance to our society, for you are the builders and the building blocks of our society. You enable and empower new mothers, fathers and families to ensure the best possible start to family life. You create foundations on which our social capital grows and progresses, ensuring the development of a robust and dynamic economy and society. Today, I address the motion I laid on the table earlier this year in acknowledging that this house recognises:

(a) the key role of the professional midwife in the provision of accessible, affordable midwifery-led care for women and babies;

(b) the evidence that demonstrates midwifery-led care provided by educated, experienced, professional midwives promotes improved quality of care and wellbeing outcomes;

(c) the role of the midwife is key to forming positive foundations critical to the first year of a child's life; and

(d) that on 5 May, as we recognise International Day of the Midwife, we pay tribute and acknowledge the valued and valuable work of all midwives and their vital role as we all commit to champion and promote this pivotal model of care and professional practice.

This year we acknowledge the theme: Midwives—Making a Difference in the World, and while we gather early for International Day of the Midwife, which is celebrated on 5 May, this theme is highly appropriate for what I will talk about today.

Transition to parenthood begins during pregnancy, when the guiding hand of a midwife has been demonstrated to enable better health and wellbeing outcomes. Midwifery's complexities see its ethos and practice based in both science and art, coupled with expertise, professionalism, intuition and caring, in one of the most intimate of relationships on this planet: a relationship to be revered, honoured and respected.

Many of you know that I spend much time advocating, talking, raising issues, holding forums and discussions, writing letters and arranging meetings to present our case to decision-makers, including the minister. I put to you all here that, while the conversation continues, the time for change and action has arrived and that this change and action be harnessed through the clarity of three main focal points: first, I propose a multimedia statewide campaign on what a midwife is; second, converting recognised wellbeing outcomes of midwifery-led care into care for all; and third, constructing a model of midwifery-led care that best facilitates safe and universally accessible services of choice and promotes good foundations for babies, mothers and families.

Firstly, the statewide multimedia campaign on what is a midwife and the importance of your role, with a promotional advertising campaign to expand the understanding of the role of a midwife. As a result of a robust forum of midwives and obstetricians that I hosted, you came up with what was really needed in this state to progress midwifery-led care. Unanimously, the campaign was identified as number one. I sent the letter to the minister and discussions are in progress, and I am sure we will see results soon.

Anecdotally, we know there is, generally, limited understanding of what a midwife is. Words used to describe a midwife could include: professional, science, trust, relationships, hands on, available, empowering, enabling, collaborative, university educated, experienced, accessible, affordable and safe. Midwives differ from nurses—I know because I am both. Like architects and interior designers, they are both different but have a thread of commonality. For nurses and midwives, there is this thread of commonality: it is the humanness, the connector of ultimate best possible outcomes.

When the first campaign is complete, all South Australians will know what a midwife is and does, why you are important to them, and why you are necessary to building the health and wellbeing of this state and how and where you can be accessed. Before I move on to the second point, I would like to set the scene with some words from Tessa, who is here today, as she reflects on her journey and the importance of a midwife overseeing her care. I would suggest that Tessa is representative, in many cases, of her peers. Tessa writes:

As a first-time pregnant woman, I had a rough idea of what I wanted for labour and birth, but I didn't know where to find it. I wanted to be nurtured, calm and well-attended during my labour by someone I trusted. I wanted my baby to be delivered safely and naturally into my arms. I wanted to be respected and heard as a woman in the midst of one of the most important rites of passage of [my] life.

When the time came for us to consider having another child, I knew what I didn't know last time and started researching. I discovered the midwifery model of care—I had not realised that the State offers very high quality Midwifery Group Practice programs which women can access for free. In discovering the midwifery model, I realised the absurdity of looking to the private obstetric model for this kind of responsive, one-to-one care.

Under the care of an inspiring, diligent and committed private midwife, I went on to have two more babies naturally—both were 'vaginal births after Caesarean'. These births healed my past trauma, gave me a new appreciation for the grand design of birth and left me with a lasting passion for midwifery care and maternity service reform.

Without midwives, women face increasing and unnecessary interventions which might be safe in the short-term but create longer-term morbidities physically and emotionally. Women need midwives.

Thank you, Tessa, for those words. My second point urges converting well recognised health and wellbeing outcomes of midwifery-led care into accessible care for all. The evidence clearly demonstrates that midwifery-led care gives results. After nearly 15 years of midwifery group practice in our state, the statistics are not publicly discoverable. It is time they were.

We know from studies and research that midwifery-led care produces better outcomes for mothers and babies and that this model of care promotes increased normal vaginal births, decreased use of epidurals, decreased use of drugs and their side effects, decreased post-delivery haemorrhage, and decreased physical injury to women by way of episiotomy or instrumental intervention. With this comes improved mother-baby attachment and a smooth return to life post delivery. Incidentally, this model of care gives cost savings of around $900 per consumer for a woman under the care of a midwifery group practice, compared with standard hospital care models.

Only 15 per cent of child-bearing women in South Australia have access to a midwife-led continuity model of care. That translates into 60 to 80 women per month or around 700 to 1,000 per year who miss out and cannot access care of their choice. In fact, as we have heard from Tessa's account, many do not even know that they have this choice. We must make this well known and accessible.

Thirdly, collectively we must put on the table our ideal model of midwifery-led care. We must build it, own it and champion it. Our model must cover all aspects and be the continuum to facilitate and provide best accessible care of safe choice for every woman, baby and family. It must demand a policy focus and a designated budget line.

I will begin this section by acknowledging our shared disappointment as we witnessed a missed opportunity with the announcement of the strategy of Transforming Health, a strategy with perfect synergies for midwifery-led care. Last year, there were the associated ambassador announcements with not one midwife amongst the ambassadors. Midwives deserve better. In our model of care I propose:

midwives are recognised for their expertise in general or specialist fields—antenatal, delivery, postnatal;

midwives have ease of access to care for women at home and/or in midwifery group practices with admitting rights to hospitals (which is now starting to happen) to complete a delivery as needed;

midwifery group practice has enough space so that every woman has access to the service;

midwives are involved early as we know that the first five years of life are important as development and neural plasticity of the brain are crucial in these few years;

midwives can detect and intervene on any issues, including child abuse, neglect and domestic violence;

midwifery university graduates have access to hospital graduate places. We must increase this number not decrease it. Apparently at the moment, we have 50 places for around 120 students. This is not good enough and we need to encourage innovative ways to address this issue. We must halt the pending known midwifery shortage and the pressures of double shifts and excessive hours;

midwives specialised in child health education, preventative and educative support to mothers, fathers and families;

a specialised 24-hour parent helpline that is easily accessed;

Torrens House live-in residential assistance and education for parents is once again open for business 24/7;

mothercraft nurses work side by side with registered midwives offering a full complement of care and education and wellbeing assistance; and

we value and grow innovation, as we saw last year with the University of South Australia's opening of their midwifery-driven clinic, where professional midwives practise alongside student midwives. This is very innovative and very proactive and needs to be encouraged.

The question has to be asked and decisions must be made: do we want to provide best care with choice to build our families, strengthen our communities and set the direction of our future? I say yes, and so we must insist on policy and a budget line to address this in a determined and strategic manner. We need to be deliberate and willing to move ourselves to where we know we can make the change. We must speak our truths to bring clarity and action. This may cause discomfort to others, but this can loosen the status quo, with the associated momentum bringing vision to reality.

Women, babies and families of South Australia deserve our best service, and we owe it to them. We must champion and provide this. I am really honoured that you are present here today so that I can speak with you and about you and so that I can thank you for all you have done, all you are doing and all you will do for South Australia and South Australians. Come 5 May, I wish you all a very happy International Day of the Midwife.

The DEPUTY SPEAKER: Hear, hear!

Dr McFETRIDGE (Morphett) (12:16): I think this is the third or fourth time I have spoken on this motion or a similar motion in this place. I congratulate the member for Elder on bringing this motion to this place; it is very important. Why is a bloke standing up and talking about this? It is because I owe my life to a midwife. I was born at home in England. It was a January day, snowing hard outside. The midwife had come and sent my father off to get the doctor. He fell off his bike a couple of times in the snow going to get the doctor.

My aunts were outside digging up bricks from the backyard to jack up the bed because the midwife had said the bed needed to be higher. By the time the doctor arrived, the midwife had done what she had done so many times before with a huge amount of expertise, professionalism and care: she had delivered another baby, and that was me. I should mention that my brother Ian was also born with a midwife's care. I was 7lb 2oz; I was quite moderately sized. Ian was 11 pounds something. He was a big boy.

Now they would be in hospital with intensive care all around them, but at the time, the midwife took care of this, and why? It was not just because of the science behind her training, but because of that personal expert knowledge. There is nothing more important in medical care of any sort than that hands-on experience, particularly in such a personal and important episode in anybody's life as having a baby. Having somebody there who can give professional expertise with a massive amount of experience behind them and who knows what to do to calm the mother down and make sure everything goes well is so important. My aunts Anna and Jean were midwives out at the Queen Vic.

Everybody in this place would be strongly appreciative and very supportive of the role of midwives in South Australia. According to the information I have, there are 33,490 midwives and RN midwives registered in Australia. That is a huge number. They are backed up by a health system that is geared for in-hospital births but, as I have said, I was born at home and people are still choosing to give birth at home, out of hospital circumstances.

We know that midwives are there to support mothers, support families and support the whole process, not just at the birth but also with prenatal education and information, making sure that everybody knows what to expect. My son was 10lb 6oz, my daughter, Sahra, was 8lb 13oz, and I once said to my wife that it was like shelling peas. I cannot repeat in here what she said to me about shelling peas and giving birth; it was not quite like that.

Mr Pengilly: It's a wonder you're still alive.

Dr McFETRIDGE: I can't fight very well, but I can run fast. It is so important to make sure we have midwives there who know what they are doing. The most important thing we can do in this place is continue to recognise days like International Day of the Midwife because members are able to get up and give their own personal stories. I think that is an important part of not only recognising midwives as part of the medical profession as medical practitioners but also showing the real connection we have in this place with what is going in the real world.

The role of midwives is becoming more technical now. The expectations are getting higher. The requirements are getting higher, and having nurse practitioners, having Professor Dabars in the gallery with us today, shows the level of training that is available now so that we, as patients and recipients of medical care, are getting the best care. I emphasise again to all the people who are here in the gallery today that if you added up the years of experience it would be thousands of years of collective experience. It is that experience, that bedside manner, that tender, loving care—and I do not think that is putting it too strongly—that makes our health system, particularly the obstetrics and gynaecology part of it where midwives are involved, very special.

Being a grandfather now, knowing that my grandchildren were born with the expert care of midwives—doctors were there helping, but the midwives were doing most of the work—is so important. This is an important motion. I will not say any more; I will let others speak on it. It is a very important day and I am very pleased to be able to lend my assistance to recognise the worth of midwives and the importance of this day.

The DEPUTY SPEAKER: Hear, hear!

Ms COOK (Fisher) (12:21): I am very pleased to rise to support my colleague the member for Elder in this motion. The member for Elder is a tireless advocate and voice for all midwives in this place. The motion moves the recognition of midwives' leadership, the influence they have on wellbeing and health because of the contact they have in the first year of a child's life, and pays tribute not just to midwives but to the advancement of care in the model that midwives provide because of their advocacy for women across the decades.

The world of the professional midwife is as interesting as it is challenging, rewarding and inspiring. As a general nurse, I have the utmost respect, admiration, and maybe even a tinge of jealousy at times, for the way all midwives go about their loving and nurturing contact with mums, babies and families. I have to say my role as a level 3 nurse in a mixed general obstetric and gynaecology ward was one of the most rewarding and enjoyable roles that I have had during my 28 years of clinical nursing.

The chance to assist women in the birthing of their children at the most intimate time of life, the opportunity to provide love and reassurance to women with antenatal crises, and to undertake my work with very tiny babies watching on from their cots while newly anointed parents took a well deserved rest, were some of the most special times in nursing for me. The role is privileged, satisfying and held in the utmost regard.

In a world where there is constant pressure to improve efficiencies in patient care, achieve better patient outcomes and ensure that we clinicians deliver best practice patient-centred care, the leadership looks to midwives who lead the way in these forms of practice. Midwifery-led care models such as family birthing suites, discharge planning and follow-up models have led the way in this regard for many years. The member for Elder and I often refer to these models in our advocacy to the Minister for Health, particularly when describing ways in which clinical pathways are developed and best delivered.

General nurses have long understood the benefits of these models, and we look to midwives for leadership. I think we are getting there, albeit slowly. Trust me, the wheels turn very slowly, but with the acknowledgement that nurse-led care is what our community needs, and in fact what our community wants, I feel very happy to see that endoscopy scope-type care, nurse-led care, is coming. I am pushing very hard for nurse-led models around palliative care.

Thank you all for your care. Thank you for your kindness and love in the most intimate and challenging times of life. Thank you for helping families in our state. Thank you to all midwives working in the community, family homes, clinics, children's centres and GP practices. Thank you to midwives working in rural and remote settings, and of course, thank you to midwives working in acute settings, antenatal labour, postnatal and of course neonatal care. You are all awesome and we salute you. I look forward to celebrating International Day of the Midwife again on 5 May.

Mr TRELOAR (Flinders) (12:24): I rise today to support this motion acknowledging the International Day of the Midwife and also to acknowledge midwives everywhere, particularly those who are gathered in the gallery today. This motion recognises the key role of professional midwives in provision of accessible, affordable midwifery-led care for women and babies, it recognises the evidence that demonstrates midwifery-led care promotes improved quality of care and that the role of the midwife is key to forming positive foundations critical to the first years of a child's life.

The member for Elder has identified the differences between a nurse and a midwife, and I suspect that these days there is even greater divergence occurring between those two professions. I am married to a nurse who, when you could, trained back in the day at the Tumby Bay District Hospital. She went on to gain her degree and become a registered nurse. I can say in this place that, had it not been for four children in five years, I know for a fact that she would have gone on to pursue midwifery. That was not to be, and I am sure that there are lots of stories like that.

The International Day of the Midwife is held each year on 5 May and was launched in 1992 by the International Confederation of Midwives. The annual event highlights the work and role of midwives and midwifery. Midwives work in a range of environments that include hospitals, birthing centres, community centres and women's homes. Some midwives are employed by health services and organisations; others are self-employed as privately practising midwives. All midwives are providing vital services in birthing throughout our community.

The number of midwives registered in South Australia in 2016 was 522, an increase of almost 12 per cent on the previous year. I have no reason to believe that that increase in the profession will not continue. Midwives help to deliver many of the around 20,000 births in South Australia every year. For those who are sitting here today and who are unaware, I represent a distant and far-flung electorate that encompasses Port Lincoln, Cowell, Ceduna and all the way out to the Western Australian border.

In my electorate, hospital birthing is only possible now in Ceduna and Port Lincoln and also, for some, in Whyalla, which is in the member for Giles' seat. The reality is that there are only three hospital options for mothers-to-be on Eyre Peninsula. There are many reasons for this, but one, I am sure, is the difficulty in attracting health professionals, including midwives, to the more remote areas of South Australia. What it means, of course, is that mothers-to-be who live in these more remote areas must often travel many miles in order to have their babies in a hospital environment.

Last weekend, I was talking to a senior health professional, and there is no doubt that the demand for midwives in country areas is increasing and will continue to grow to support those country mothers who are giving birth in more remote areas. Aside from all that, we must continue to recognise the invaluable work and achievements of our health professionals. Midwives play an integral role in supporting the health of mothers and their babies through providing proper care before, during and after pregnancy, and acknowledging and supporting them in their work is of enduring importance. The International Day of the Midwife on 5 May provides that opportunity. I support the motion and I say a big thank you and congratulations to midwives everywhere.

Mr BELL (Mount Gambier) (12:28): I will be very quick because I know we are almost out of time, but as parliamentary secretary for regional services I think it is important to acknowledge good work when the government does do good work. I want to commend them for a new initiative that has just been rolled out, that is, the midwife manager for maternity and neonatal services across regional South Australia, an initiative that brings together the skills of midwives in country locations, who can feel isolated or disconnected. This initiative, this program, brings those midwives together, provides a lead role in working in partnerships amongst our country birthing hospitals and, of course, those midwives in country as well. It really is a great initiative and enables country midwives to feel connected, to share skills, and to tap into other skills located around our wonderful regional and rural areas.

It was a role that was previously under the director of nursing but, of course, that is just one of many roles the director of nursing needs to undertake. To have this type of special focus on midwives in country areas is to be commended. The only thing I would ask is that I believe the trial finishes in June this year, and there will be a need for funding. I encourage the government to look at this service very seriously. Representing a regional area, I know midwives are crucial to our country and regional services.

Ms DIGANCE (Elder) (12:31): I would like to thank those who have spoken on this motion this morning: the member for Morphett for his really interesting recount, which was excellent; the member for Fisher for her insights as well; and the members for Flinders and Mount Gambier, both from rural settings, for their insights. I really appreciate that, as I know everyone here would also appreciate that.

What all of us gathering here in this house does is give affirmation to this amazing profession of midwifery. Midwives are vital and key to the success of our families, which in turn builds successful and strong communities. I thank them for what they do, I welcome them to the house, and I know that we are going to share lunch soon, which will be very good. I thank them for coming and I thank everyone who has supported this motion today. I commend the motion to the house.

Motion carried.