A Big Month for Birth Reform: A Wrap on the Good and Bad of State and National News

This month has been BIG for birth and reproductive care reform in my home state of NSW, in other states and nationally too. Some of the news is good, some doesn’t go far enough and some is worrying, but all of it is important! Here’s my wrap up, in no particular order.

Note: This is not an update on birth-related research. If that’s what you’re looking for, I highly recommend joining Dr Sara Wickham’s mailing list.

The NSW Select Committee on Birth Trauma has now tabled its report to the NSW parliament.

The report identified five main findings, which are:

Finding 1 - There are a number of individuals who have suffered preventable birth trauma in New South Wales and the experiences of the people who gave evidence to this inquiry are distressing and unacceptable.

Finding 2 - That urgent efforts must be made to address avoidable and preventable factors that contribute to birth trauma.

Finding 3 - That in some cases of birth trauma, women have recounted that they experienced this as a form of violence.

Finding 4 - That prospective parents need to be provided with clear and comprehensive education about all aspects of pregnancy and childbirth so that consent given to any obstetric intervention is fully informed.

Finding 5 - That a 'one size fits all' approach is inadequate for the New South Wales maternity care system and that tailoring care to meet the needs of individuals is essential for improving outcomes.

Groundbreaking, right?! Not really news to most of us, but it’s good to get it down and in front of the politicians.

These five findings then inform the 43 recommendations the Select Committee has made, which you can read on pages xv-xx of their report. While some advocates will say they don’t go far enough, I can only see improvements to maternity care coming from the recommendations made.

The Select Committee’s very first recommendation is:

That the NSW Government fully fund and implement programs, policies, and strategies to address all ten goals and associated objectives from Connecting, listening and responding: A Blueprint for Actions – Maternity Care in NSW as soon as practicable and ensure ongoing evaluation of the effectiveness of these programs, policies and strategies

This in itself would be massive, and was one of the key recommendations welcomed by the Australian College of Midwives (ACM) in their public response to the Select Committee report.

In their response, the Maternity Consumer Network (MCN) highlighted “the Inquiry's recommendation for a review of the complaints process and public reporting of data by the Health Care Complaints Commission” as well as recommendations for informed consent training for all clinicians, funding for continuity of midwifery care and increased access to homebirth. MCN did raise concerns with a couple of recommendations though, which you can read about here.

Unsurprisingly, RANZCOG didn’t appreciate the prioritisation of midwifery staffing or continuity of care (despite the research showing how helpful it is for low and high risk pregnancies). They did however support the recommendation to invest in GP obstetric models of care in rural areas, which they say “are essential in enabling women in regional, rural and remote areas to have their care managed closer to home with support networks.”

Unfortunately, the Select Committee’s recommendations are not legally binding - it is up to the parliament to discuss them and decide which will be enacted and in which order of priority. The government is required to respond to the report within three months, so watch this space, particularly the “Reports and Government Responses” tab.

While RANZCOG aren’t usually high on my love list, they have done right in challenging an amendment to abortion policy proposed in Queensland by state MP Robbie Katter (conservative federal MP Bob Katter’s son). Quoted in their public response, Professor Kirsten Black, Chair of the RANZCOG Sexual Reproductive Health Committee states:

“The Qld Termination of Pregnancy (Live Births) Amendment Bill is ill-advised, unnecessary, and if enacted, would lead to considerable stress for both practitioners and people needing these services. The bill has the potential to further reduce equitable access to abortion and it is vital that we don’t create additional obstacles to people’s reproductive rights.”

It is a well-used tactic of the far right to erode access to abortion by passing gradually more restrictive and red-tapey legislation. We saw what happened in the US and need to act against such attacks whenever the threat arises. Abortion is healthcare. If you are in Queensland you can find your electorate and contact your state MP here and let them know your thoughts.

Back to national issues though. On May 16th the Senate passed a bill reforming access to private midwifery services. As it stands, mothers and birthing parents seeking to access an endorsed (private) midwife needed to get a referral from a GP in order to claim a Medicare rebate on prenatal and postnatal appointments, or access the PBS for relevant medications prescribed by endorsed midwives or nurse practitioners. This additional layer of red tape (and what some have called the “gatekeeping of birth”) will be removed as of 1 November 2024.

Unfortunately, there is still no rebate available for intrapartum (birth) attendance.

You can read the ACM’s response to the change here, and coverage of the response from Nurse Practitioners here.

The 2024/25 national budget also brought news for birth services and reproductive services. The budget report states:

The Government will provide $56.1 million over four years from 2024-25 (and $0.4 million per year ongoing) to improve access to sexual and reproductive healthcare for women in Australia across the life-course, including support for women's health services on miscarriages, pre-term or early-term births, stillbirths, early pregnancy and menopause.

The breakdown of this and relevant funding announcements can be found on pages 132 and 133 of this document (that’s page numbers at the bottom of the document, if you’re typing in the search box use number 146). A note also that this funding is separate to moneys that are already allocated to the states for healthcare, so don’t get a shock when you see essentially nothing for direct maternity care.

One big piece of news in the budget relates to homebirth, and though intentions are likely good here, we might need to swing into action at some point.

Since 2010, private midwives have been able to attend homebirths without insurance. (You can read about how homebirth came to be seen as uninsurable by private insurers in this excellent 2016 article entitled “Gaye Demanuele And The Politics of Homebirth” by Dr Petra Beueskens.)

What was originally introduced by the federal government as a two year exemption (essentially meant as a stop-gap measure until a private insurer came on board again) has been renewed annually since 2012. The latest budget announcement specifies:

$3.5 million over four years from 2024-25 (and $0.4 million per year ongoing) to expand the Midwife Professional Indemnity Scheme to include indemnity insurance cover for privately practicing midwives providing low-risk homebirths and intrapartum care outside of a hospital, and for specified entities providing Birthing on Country models of care.

This is good news at first glance, and was met with celebration on social and traditional media. Indeed, it is great to continue supporting both out of hospital birth and Birthing on Country for those who want to access these models of care. The joy must be interpreted with a hint of caution though, as the insertion of the phrase “low risk” sets alarm bells ringing. This is why.

In Australia, pregnant women and people are lumped into one of two categories, “low risk” or “high risk”. It is one or the other, no “medium risk” or grey area allowed. Otherwise healthy women with an elevated BMI, people taking thyroid medication, anyone who is pregnant with a baby conceived by IVF, people with antenatal depression or anxiety, anyone with a previous third degree tear, all VBACs and generally anyone with any other previous “obstetric history”, “risk factor” or “condition” you can possibly think of are considered “high risk” in the world of maternity care.

If the intrapartum indemnity insurance is changed to cover low risk births only as it is currently worded, this will effectively kill private practice midwifery. One homebirth midwife told me 90% of her annual caseload are women who have been “risked out” of continuity of midwifery care programs in the public health system, which usually accept low risk women only. This midwife is still working within her scope of practice, and has an annual caesarean section rate of under 5%.

I have contacted the ACM to ask what is being done about this and if there is anything we as midwifery “consumers” can do to ensure the wording is altered to reflect the nature and scope of homebirth midwifery. They have assured me they and other stakeholders are onto it, and there is time for adjustment prior to changes to the insurance scheme scheduled for July 2025. So again, this is a case of “watch this space”. If this is something you are passionate about and you want to make your views known sooner rather than later, you may like to send a short email to your local MP, the Minister for Women or the Health Minister about it.

Finally, it would be remiss of me to conclude a newsletter regarding pregnancy and birth care without discussing the continued onslaught pregnant women, birth parents, babies and children are facing in Gaza. Two days ago, Israel bombed a maternity hospital in the supposed “safe zone” of Rafah. It was one of the main places Palestinian women went to give birth, and one of last places with a working maternity unit. Multiple premature babies were already sharing humidicribs in the building.

The Israeli attack on Gaza is ongoing, relentless and unconscionable. There is no plausible excuse or justification for herding pregnant women and children into “safe zones” only to attack them. Please join me in contacting Foreign Minister Penny Wong to lobby for an immediate ceasefire in Gaza and the end of the Israeli occupation of Palestinian territory. If you wish to join other mothers in taking a stand and connecting with others to help make your advocacy more sustainable, you may also want to consider joining the Mums For Palestine group.

Do you have thoughts or comments? I have opened up a thread in the forum of my Default Parent Project online community membership to discuss the recommendations and proposed reforms above. It’s $15 a month (standard price) or $9 a month (concession, marginalised and single parent price). This gives you access to the aforementioned forum, a collection of my courses and resources, private blogs and regular online events. Our next online circle for members is Sunday 16th June at 9.30am AEST (Sydney time).