Mr DUTTON (****son) Page 26
This is an issue that is fundamentally about choice. It is extraordinary for a health minister to effectively prohibit mothers and parents around the country from having an appropriately qualified health professional in attendance at childbirth. I acknowledge that there is a great diversity of opinion on homebirthing, both within the medical and health fraternity and in the wider community. At every stage, though, all reasonable parties to such debate would rightly acknowledge that homebirthing is not an appropriate option for all women, and I would certainly strongly recommend that any patient, in particular expectant mothers, be properly informed and that they consult relevant health professionals. However, I am not here today to debate the merits or otherwise of homebirthing; that is for others. I am here to defend the right of intelligent, informed Australian adults to have a choice?to be entitled to decide for themselves.
To date, homebirthing is the choice of only a small proportion of women?in 2006 it made up 0.26 per cent of all births. However, it is naive to suggest that all women will simply surrender this option. The Minister for Health and Ageing knows that there are a small proportion of mothers and parents who will continue to choose not to enter the hospital system for a childbirth. That is their choice. This measure will just drive homebirthing underground, with parents unable to access appropriate care, jeopardising the lives of not just the unborn babies but also the mothers themselves. Childbirth is an intimate and personal decision for families in consultation with health and medical professionals. It is not appropriate for the Rudd government or Minister Roxon to mandate the conditions of childbirth for all women across the country. This is a nanny-state Labor government treating with contempt the rights of mature adults to make informed decisions.
It might be difficult for this government to accept, but the Prime Minister and the Minister Health and Ageing do not always know best?Australians are able to make informed, educated decisions that deliver good outcomes for themselves and their families. If the minister is unable to satisfactorily resolve the issue of indemnity insurance for midwives then at least the proposed registration requirements should be amended to allow existing services to continue?the so-called status quo option.
In order to have an informed debate on the provision of indemnity insurance to cover affected midwives, the government needs to release the detailed actuarial modelling that it used for its proposal.
The Senate Standing Committee on Community Affairs inquiry examining this legislation has received over 1,800 submissions and was due to report on 7 August 2009. The reporting date was moved to 17 August due to the overwhelming public reaction. Whilst we do not oppose the passage of this bill today on the basis of the homebirth outcome, we do reserve the right to move amendments in consideration of the recommendations of the Senate committee?s report. We are opposed to making homebirth illegal and we will fight for choice. I put the government on notice that we are carefully considering the committee?s recommendations that were released in this regard.
(Argument with Roxon - page 29)
Dutton continues: I am not getting into some petty tit-for-tat with the minister, who obviously wants to distract from the message. This is a slap in the face for those 1,800 people who made submissions to the Senate inquiry on this very bill. These people were concerned about the fact that this government is going to, by way of this legislation before the House and the national registration and accreditation process, make it illegal for parents to have a homebirth with a midwife in attendance in this country. That is unacceptable from a government and from a minister, and it is no wonder that the backlash from the backbench and from her party has been quite outstanding.
Ms Roxon?Mr Deputy Speaker, on a point of order. I am quite happy for the member to use other forms of the House to debate what is an important issue, but it is not part of any of the three bills that we are currently debating. The shadow minister, as a previous minister, knows that he should make his comments relevant.
The DEPUTY SPEAKER?It is my ruling that the member for ****son?s remarks are relevant to the long title of the bills.
Mr DUTTON?Thank you very much, Mr Deputy Speaker. It is no wonder that these patients, these expectant mothers, these mothers who have been through the process of homebirthing and who have experienced the benefit of having a trained midwife in attendance, are so frustrated at the approach of this government, when you see the minister?s petty interjections in relation to this speech. I cannot believe that a Labor government with the people who sit opposite, who champion the cause of choice, of the rights of women, are effectively taking away the choice of those women around the country. It is no wonder that there has been revolt in the Labor Party caucus against the minister?s decision. This is a bad outcome for those women who have a choice. Some people agree with homebirthing; others do not. But the reality is: they have a choice to make, and the fact that this government has taken that choice away is a very sad indictment of many people within the Labor Party?not just in this place but in the other place as well. I do not care what people in the Labor Party are saying in private to homebirth mothers; they are saying absolutely nothing in public. It is worthless for them to continue to show sympathy and to say that they are going to advocate behind the scenes on behalf of homebirth mothers when not one Labor female or male MP in this place, or Senator in the other place, has spoken out publicly against this minister?s stance. I know that there are dozens of people within the Labor Party who are talking to homebirth mothers in their electorates, in Canberra and in other parts of the country, and they are saying to people in those conversations that they do not agree with what this minister is doing. She does not have the support of the caucus and yet somehow this has been rammed through on them. It is a pathetic example of representational politics by the Labor Party in this country that many of those women are not speaking up.
Whether the Prime Minister has gagged them or if these people are going to stay true to the convictions that they commit to in private then they should be coming out to provide public support to their statements and they should be talking against this particular provision by Nicola Roxon. That is the important part: this provision is by Nicola Roxon, who has championed herself as some sort of advocate of nurses yet she is saying to midwives who want to continue in the practice of homebirth that effectively they are going to be fined $30,000. That is completely outrageous.
In looking at the outcomes in this bill, I have spoken to the positive outcomes and I have addressed the issues which I think need to be addressed. We now have the benefit of the Senate inquiry report, and we will certainly be looking at the option of moving amendments until this government gets it right. Until this government gets it right, we will continue to advocate on behalf of those thousands of mothers around the country who are currently being ignored by Labor members across the country. We will listen and stand up for their rights. We will stand up for choice. We will listen to their concerns because those concerns are not limited to a handful of people. Even people who do not agree with homebirthing say that those who choose to take up such an option should have that right into the future. That this health minister would take that away certainly underscores some of the difficulties not just around this policy and around the bill that is before the House but around the general approach to the issue of health in this country.
Mr NEUMANN (Blair) page 31
I support and have always supported the right of women to self-determination when it comes to issues of pregnancy and their birthing experiences. I believe, as a father of daughters, that it is my daughters? right to choose in the circumstances what they do with their bodies and how they control their decision making concerning pregnancy and the birth of children. I have always taken that view because I believe it is important that we give women as much autonomy and self determination as we possibly can.
We have looked at a number of models of care and we think that being involved in a collaborative teamwork approach?particularly with obstetricians and GP obstetricians? is the best way to go forward. We think it is important to listen to what the doctors had to say on this and to take note of the more than 800 submissions. As the minister said in her speech, we have ?listened to the collective voice of Australia?s mothers? and also look forward to the viewpoints of midwives across the country. We are changing the laws to benefit women across the country, and I think an insurance scheme is very important.
There are issues concerning homebirths, and I have been one who has advocated strongly for homebirths in the past. My wife and I chose to have our children in a hospital setting, but I recognise the right of women to choose their own birthing experience. The Maternity Coalition in Queensland has provided me with some information concerning the rate of homebirths. According to the Australian Mothers and Babies report, in 2006 there were about 708 homebirths in Australia, but that report noted that homebirths are not always recorded.
There were about 20,548 homebirths in the UK in 2007, which represents about 2.7 per cent of all births, according to the UK Office of National Statistics. The homebirth rate in New Zealand is estimated by the New Zealand College of Midwives at seven per cent and the rate of homebirths in the Netherlands is approximately 30 per cent. The situation is that women have the right to choose, and I believe that is the case. The minister has publicly said on numerous occasions that she recognises that a very small proportion of women would like to have homebirths, and she is currently investigating some way that this can be provided as an option, making it possible without making the indemnity insurance unaffordable. I urge the minister to work with all stakeholders to ensure that this issue can be resolved.
I urge the minister to continue to work with stakeholders, with midwives, with women who want a homebirth and with doctors and nurse practitioners across the country to ensure that women have the option and the right to determine how they will undertake what is honestly a beautiful experience, the sort of experience that they will cherish for the rest of their lives?giving birth to their children. Those of us who are parents in this place can remember and will always remember, however long we live, those occasions when our children were born?holding a young baby in our arms and realising the responsibility that we have for that child.
This is a sensitive and delicate issue and it needs a lot of attention and care. I commend the minister for this very significant reform and I urge further consultation to resolve any currently unresolved issues in relation to the matter.
Mr. Chester - Gippsland page 33
...who are we to be taking away a woman?s right to choose a homebirth, as we are doing with this legislation before the House? By excluding midwives practising homebirths from the professional indemnity insurance cover and making insurance a condition of registration, we are effectively, if not technically, making it unlawful. Being subject to a $30,000 fine is certainly a huge discouragement to the midwives. I hold grave fears for the health and safety of women and their babies if we do in fact force homebirths underground.
... the one point that they all agree on is that the welfare of Australian mothers and their unborn children must be paramount in our considerations. That is why I am uncomfortable with the failure of these bills to recognise the right of a woman to choose a homebirth with a qualified and registered midwife. If we do force this practice underground, we will regret the day that we voted to make it harder for women to choose a homebirth.
... I acknowledge, as do the registered midwives I have met with, that homebirthing is not an appropriate option for all women, nor is it the choice of the overwhelming majority of women, but it is the choice of a small number of Australian women and, if it were properly accommodated in the legislation, there would be the possibility, indeed, that more women would take up the option in the future.
... No disrespect intended, but I am unconvinced by the mainstream medical profession?s more extreme arguments against homebirths. I accept there is an element of increased risk in some circumstances, but it is entirely manageable in the majority of cases with the care and attention of a highly qualified and registered midwife. I cannot escape from the fact that women should have choice when it comes to deciding what they do with their bodies, and that extends to the issue of childbirth. I strongly urge the minister to continue working with the states and territories to resolve the issue of indemnity insurance and amend the legislation to allow existing services to continue to be offered.
Ms King, Ballarat Pg 37
... There is nothing inherent in this legislation that makes homebirth unlawful. Whilst it is only a very small proportion of women who choose the option of homebirth, as I stated at the outset this choice is just as valid and important as the birthing choices of women who do not homebirth. I am assured that the government is currently working with the states and territories, and the minister is working with her department, on this issue. It is certainly an issue that I wish to keep a close watch on.
Mr Laming, Bowman Pg 44
(The govt has said) ?This is what we?re doing for homebirths. We?re going to make registration contingent on your no longer doing homebirths. If you contemplate a homebirth, there will be a $30,000 fine.? There is no plan to put that on the Medicare safety net, is there, Treasurer? No way. You are attempting to snuff out homebirths. We would be the first country in the world to do it. That is a dreadful shame.
The government should have had this worked out long ago. The evidence speaks strongly to this. The Cochrane database tells us that there is no evidence that homebirths in a proper, hospital-supported arrangement cannot be achieved. We have the evidence from de Jonge and from Olsen. There has been metaanalysis in Denmark. A study of 529,000 Dutch mums has been recently published, as has Symons in the British Medical Journal and there are other sources. If it is done properly, if high-risk mums are taken out of the study and we look at the ratios, we know that there is no significant difference in outcomes. You can talk to Hofmeyr, who authors the Cochrane collaboration, who says there is no difference in danger for low-risk mums to deliver at home or in a hospital. In fact, Cochrane, which is the gold standard for medicine, goes another step and says that, where a homebirthing service can be supported by a hospital arrangement, mums should be given the choice. But in this Labor legislation I see homebirthing being snuffed out. I can see lots and lots of people in the gallery, many of whom would never choose homebirth, but there are a proportion who would. For those mums out there, I am telling you: this side of the chamber is standing for your choice to do it in a safe environment with appropriate hospital support.
Let us be completely frank about this. Not everyone is going to choose a homebirth. But, in every country in the world bar this one, it can still continue. In the Netherlands, something like a quarter of all births are done at home.
You need to look at the choice, the quality of care and the fact that these home deliveries are done by committed professionals. This legislation is snuffing that out, closing it down. What are you going to do? Are you going to achieve a complete elimination of homebirths in this country? N-o. Are you going to drive it underground? Probably. Are you going to take away the qualified midwives by denying them registration if they turn up to a home delivery? Y-e-s. So what are we left with? We are left with further marginalisation of homebirths, less support for homebirths and worse outcomes in a global context where home deliveries can be done safely. Health Minister, you have had plenty of time to get this right. This did not pop up on you yesterday. You have been lobbied consistently by those who support homebirths. In my electorate of Bowman, homebirths will be snuffed out. I am telling you, sneaking this rancid stuff into the middle of ALP legislation, sticking a bit of ALP dill on the top and trying to pass it off as a revolution in health care is a complete disgrace. It is not too late. I am asking this government to take another look at this legislation.
It is time for you to support mid wifery, whether it is at home or in a hospital. They are the same women, Health Minister, that need these services.They are no different. Some of them just have a birthing plan that involves delivering at home. Why don?t you allow professional midwives to support them? Do not deny the midwives registration. Do not fine them $30,000. That is a complete disgrace. We are the only country in the world doing it.
On behalf of every woman who chooses to deliver at home and every family who would like to see that happen, I say: why should you run them down? Why should you snuff them out in the guise of health legislation that is mere penny-pinching? This is something that should be changed right now. It is not too late. Make an amendment and allow homebirths to continue in this country.
The SPEAKER?Order!
Mr LAMING (Bowman) (3.52 pm) Pg 62
... The cruel subtext of this bill is that you are consigning homebirths to the underworld of health service delivery. That is the ridiculous position this legislation places us in. It will effectively do four things: one, it will oblige registered midwives to sneak off and assist with home deliveries without anyone knowing and, in so doing, potentially be reluctant to refer young mums to the hospital care they need; two, it will potentially place registered midwives at risk of $30,000 fines purely for attending a homebirth; three, it will lead to midwives not becoming registered, not falling under indemnity protection and continuing to deliver at home and at great risk; and four?worst of all?it will mean nonregistered midwives operating parallel to if not in isolation from the health services.
The one thing that we know is that the best way to incorporate homebirths in an overall obstetric plan for a nation is to have them supported by a functioning hospital system. Let us remember that Australia is not the Netherlands and it is not Denmark; Australia is the second most sparsely populated country in the world. Yes, that presents certain challenges in health service delivery and it means that often mothers are not delivering just around the corner from a fully equipped hospital.
Fundamentally, providers are not out there trying to do wacky things with high-risk mums. Intrinsically, what midwives are doing, be they community midwives or working in a hospital, is looking after the mum and the baby. We do not have to fear that we will be promoting a whole lot of high-risk deliveries in the furthest corners of Australia. That is not what we are talking about. What we are talking about is making provision for mothers in Australia who want a homebirth to be able to have one.
Can I cast some light on two concerns: The first one?and it sounds awfully callous and very focused on cost-effectiveness? is that mums who deliver at home deliver an enormous saving to the healthcare system. That is not the pervasive consideration here, but let us remember that the thousands of dollars in bed days, the enormous risks of high-intervention deliveries?the use of forceps and vacuum extraction?and the ballooning number of caesarean sections come at a cost. The savings from homebirths would more than pay for extending indemnity to those mums who seek it and who are low-risk.
We are following a common-sense approach so that we pull home deliveries into the warm embrace of highquality, hospital-supported obstetric care. I do not think, Minister Roxon, that that is too much to ask.
Reducing stress often means a more successful labour, less need for surgical and other forms of medical intervention, and less pain relief. That has always been the banner flown high by supporters of homebirth?that, no matter what study you look at around the world, the degree of intervention and the need for pain relief is far lower. A mother is far more likely to have a normal, uncomplicated delivery when birthing at home. We tend to take our focus away from that and shift it onto neonatal death and stillbirth, issues which are still very difficult to prove. One thing is clear: the importance of delivery at home for mothers who choose it?for mothers who are mentally ready to deliver at home and who actively seek out that kind of service.
The thing is that Australia is a nation of choice. But we have a government taking the choice away. I cannot put it any more simply than that. Delivery at home should be a right. We have the hospital service that can support it and we should be fighting hard to make sure that indemnity is extended to the low-risk deliveries cohort. Of course we need provisions for high-risk deliveries. I acknowledge that. We may have to look at ways to achieve that in a large nation like this. But let us not become the first country in the world to effectively liquidate, to effectively airbrush away or to effectively snuff out the right to deliver at home. For those who choose it and know they can do it successfully, and for the professionals who make it as safe as it is anywhere in the world, we on this side of the chamber stand up for the rights of women to decide.
Mr BEVIS (Brisbane) (4.05 pm) Pg 66
... But it is clear that homebirthing is very much the option that some women choose, and choose very strongly. Indeed, I have met with women who have had homebirths and who are now pregnant? I am thinking of one lady in particular who is now pregnant and intends to have a second child by homebirth. She is?I hesitate to use the word but I think it is the appropriate one?actually scared of going to hospital. She does not want to give birth in hospital.
We need to ensure that women do have proper choice and that homebirthing is properly supported. Another thing that has concerned me is the number of caesareans that occur in Australia. When you look at the statistics, it is hard to believe that they are all performed for medical reasons. The OECD average number of caesarean sections for every 100 live births is 22. In Australia that figure is 29. Only three countries have a higher rate: Korea, Italy and Mexico. In countries like Sweden, Belgium, France and Finland the figure is 17. There is a substantial difference between the rate of caesarean births in Australia and other countries that makes me wonder whether or not all of those caesareans are done for good and proper reason.
At the moment, as my constituent correctly points out, the arrangements allow indemnity, public funding for hospitalisation and all of those services to be supported by the public purse. We need to look at doing the same for homebirthing. But we should not forget that this bill provides very substantial improvements in the recognition of midwives. It is a good bill and it deserves to be supported by both sides of the chamber.
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