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Andrew Laming (Bowman, Liberal Party)
All politics is local, but rarely is it more personal than with the moves in the last couple of weeks to deny homebirthing in this country an equal status with midwifery. Just a fraction of Australians birth at home. I would have thought that after the events of earlier this week, when 2,000 mums rallied at the front of Parliament House?and there were obviously meetings that preceded that all over this country?a message might have got through to our Minister for Health and Ageing to treat homebirths with the respect that they deserve as a completely valid way of delivering in a modern age and a developed economy. But, alas, that is not the case.
There was a small concession made on Friday as if to try and take some of the wind out of the rally, but that was far from what happened in reality. These mums know that at the moment they are isolated from, initially, the recommendations from the National Maternity Services Review, isolated from any form of indemnity cover and, of course, left out in the cold as far as community midwifery goes because they are not being supported through the entire delivery cycle for a mum. That means interrupted care and going back into what is often a clock-in, clock-out hospital maternity system which many mothers have taken a decision to move away from. Not everyone in Australia makes that choice, but we know that in every country in the world there is an option to do so and not a government system that works against it.
What we know from Cochrane Collaboration, the non-governmental group that collects, collates and meta-analyses research from all over the world, is that there is no significant difference in safety for low-risk mums between delivering at home and in a hospital. We also know that, more importantly, women should have a right to both choices in a developed economy and finally that, in fact, in hospitals themselves there are often worse outcomes for mums because of the far higher levels of intervention, and most people will relate to that.
Before I go further, though, I want to recognise that homebirths have played a really important cultural role as well. New Zealand has had this system in place for two decades. Australia has not taken the same steps. Homebirthing has had a very powerful impact on our hospital maternity services because they are a counterweight and a counterpressure, a cultural counterpressure, that says that we do not always need to fall back on interventions and in a hospital we do not always need to be interrupting the care; we do not always need to be swapping midwives at every shift. That force has come predominantly from the homebirthing movement. That must be acknowledged and often is not.
For many of us here, however, what is more important than anything is the ?perfect baby? syndrome. We want to do everything we can to have the safest possible outcome, and for homebirthers that rankles because they can say that, in nearly 300,000 deliveries performed in New Zealand, there have only been six cases where there has been an indemnity related claim made. That is very important information when we consider that question here in Australia and the cost and the actuarial context around it. We have figures from overseas about safety, which I have already outlined. But still we heard from my good colleague Senator Claire Moore at the rally at the start of the week that there was a need for more information and more evidence. I guess for homebirthing, having had the tried and true models rolled out all around the world, it is actually very hard for very, very rare incidents to be measured accurately or powerfully with high levels of evidence in a relatively small population like Australia and in a country the size of Australia. It is very difficult to do those studies, so rightly we turn to European economies where they have done nationwide cohort studies in which 530,000 mums have been analysed. The evidence comes out very clearly that homebirth has a role where it has hospital support. What we got was a two-year moratorium from the health minister, which was a duck and weave; we can see that.
More concerning is what is between the lines. There was very, very powerful and promising good-faith negotiation that models that exist in South Australia, and to a lesser extent in Western Australia, might form the basis for a national plan that would include homebirths and make them part of the community midwifery program in this country. Alas, that has all fallen through and it is a source of great disappointment for those who have worked so hard to have homebirths treated on at least an equal footing. These people are calling for a single maternity care system where everyone who is involved is registered as part of the midwifery profession, where indemnity is provided to those practitioners and where the support, the continuity, the good faith, is extended out to homebirthing. We know that that is not occurring at the moment and we will see more of this community action. This issue is not over yet and let this be a warning to the health minister that this will be a fight of great fervour, of almost evangelical zeal, because it is an issue of right. It is an issue of right for mums in a developed economy to care about a safe way of delivering babies.
Laming has an illustrious career - research into eye disease, a diploma from RANZCOG and training in the UK maternity system (no wonder he's so savvy!), clearing landmines in Kabul (!!) and now politics. No wonder he has so much credibility when he speaks with passion in Parliament. Not wanting to foam at the mouth here, I'm just increasingly impressed with every speech he gives. He was the most credible polly on Monday at the rally and now that I've done some digging, I know why!