Please note that this page is evolving as we respond to developments in the Maternity Review process, so please keep checking here to keep up-to-date.
Submissions online
The Department of Health received over 900 submissions to the national Maternity Services Review before the closing date of 31 October 2008. A report is expected to go to the Minister by the end of 2008. In the meantime, you can download and read submissions from the Department of Health website. Submissions are online from a wide variety of community groups, medical professional bodies, and personal submissions.
What is the National Maternity Review?
Why is this review important?
What you can do
Roundtable Discussions in October 2008
Contact us
Information, tips, resources
* Discussion Paper
* Questions to help you get started
* Useful facts
* Useful links
During last year's federal election campaign the Labor party committed to a national review of maternity services. That review has now begun. See this link for press release from the Health Minister, Nicola Roxon, annoucing this review.
The Federal Government released a discussion paper “Improving Maternity Services in Australia” on 10th September which can be found here: http://www.health.gov.au/maternityservicesreview
The Federal Government is using this paper to direct changes in maternity services, and is seeking responses from women and carers about how to improve local maternity care. The review will canvass a wide range of issues relevant to maternity services, including pregnancy, birthing postnatal care, as well as care for parents who have lost babies.
The review will play a significant role in deciding how government maternity funding will be targeted for the forseeable future. The flow of funding to service providers is the major obstacle in bringing the states' commitment to primary maternity services (including midwife-led care) to fruition. See here for more about federal funding.
The success of the review depends on community input, and the Government is encouraging all interested individuals and organisations to contribute. Maternity Coalition is coordinating a media/lobbying campaign and will be making a submission from our organization, but we’re encouraging women and carers to also write their own personal submission to support ours with valuable stories and real life experiences.
- Submissions to the Review closed on 31 October 2008. Thankyou to everyone who took the time to send in a submission.
- Volunteer to promote the Government’s review and the community’s chance to voice our concerns about Australia’s maternity services to your local and national media – we can get you fully briefed on the issue so you feel prepared.
- Send a copy of your submission to your local Federal MP and arrange a visit to brief him/her on what you’d like to see happen. Email wilkes@maternitycoalition.org.au
- Please consider copying your response to Maternity Coalition. Email wilkes@maternitycoalition.org.au
- Your efforts will help the extensive political lobbying and media campaign Maternity Coalition is driving. The more submissions the Department of Health and Ageing receives means the more likely they will to pursue the changes that are needed. At the same time, the Health Minister will need political support for these major reforms, so it’s important we all visit or write to our local Federal MP.
- If you aren’t already a financial member of MC, please consider joining. MC doesn’t receive government funding or grants and doesn’t have any paid staff. Currently Mums who are active volunteers are putting in many hours networking with groups and women across Australia. Your membership enables our volunteers to keep working for women's voices to be heard. Membership entitles you to our quarterly journal Birth Matters, which keeps you in the loop. Join here today.
The Department of Health and Ageing has invited Maternity Coalition to six roundtable discussions. These discussions, and the submissions, will form the bulk of consultation for the national maternity review. The topics are:
- Effective Data collection, Monitoring, Reporting and Research - Thursday 9th October
- Assessing and Managing High-Risk Pregnancy - Friday 10th October
- Workforce Standards, Quality and Inter-Professional Collaboration - Tuesday 14th October 2008
- Alternate and Midwife-led Models of Care - Thursday 16th October
- Indigenous Perspectives - Friday 17th October
- Peer and Social Support in the Perinatal Period - Friday 24th October
Please send your contact details and the roundtable discussions you’d like to provide feedback on to wilkes@maternitycoalition.org.au Liz will organise for the MC representative at that roundtable discussion to contact you.
To find out more about this campaign, or to offer your assistance contact wilkes@maternitycoalition.org.au.
We’ve tried to provide you with information here to help you get started on writing your own personal (or your organisation’s) submission to the review.
Discussion paper
Questions to help you get started
Useful facts
Useful links
The Australian Government is asking for submissions from individuals and organisations about this discussion paper. You can read it here: http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesreview
For your information, the introduction of the discussion paper makes the following points:
• “In 2005, 267,793 women gave birth to 272,419 babies - a dramatic jump of 5.9% from the number of babies born in 2004. The number of births in Australia is now the highest it has been since 1971. It seems likely that Australia is at the start of a new baby boom.
• Women and their babies must be the focus of maternity care. They should be able to feel they are in control of what is happening during pregnancy, childbirth and the postnatal period, based on their individual needs and having discussed issues fully with their care providers.
• In order for women to feel this control, the Government must recognise that pregnancy and childbirth, while requiring quick and highly specialized responses to complications, are normal physiological processes, not an illness or disease.
• Australian women and their babies should be able to access high quality safe maternity services, as close to home as possible, in line with their assessed level of risk. These services should be available for the continuum – from early pregnancy, at the time of birth and during the postnatal care period.
• Where it is necessary for women to travel away from their families and communities to access care, it is important that transport and accommodation arrangements are also addressed.
• Services should recognise the differing needs and preferences of women in relation to pregnancy, childbirth and the immediate postnatal period as well as the variable levels of risk.
• The risks associated with birthing should be kept as low as possible.
• For women who experience significant emotional and psychological consequences, there needs to be a range of accessible, integrated and culturally appropriate peer and professional support services.
• The Australian Government Review aims to elicit a range of perspectives, to identify the key gaps in current arrangements, determine what is needed for change to occur, and inform the priorities for national action.
• With its commitment to the development of a National Maternity Service Plan, the Australian Government recognises the need for national leadership in maternity care in order to address issues, gaps and priorities which concern Australian women and their families.”
Have your say – it matters
It is important that the Government receive your views and we are asking – if you can – to take some time to write a response. We appreciate that this may appear a bit of a task, so to assist, we have provided you with some guidance as to what you might like to include.
The government is looking for stories that talk about inequalities for rural women, intervention, antenatal and postnatal depression, and social and emotional responses to pregnancy and birth, among others.
Individual stories and experiences can be very powerful and so we are asking for you to provide examples of your own birth experiences.
Questions to help get you started
You don’t need to answer all the questions in the Discussion Paper. What you write is up to you, but you might like to write about :
• Your own experiences: when, where and how did you birth – did you use private or public care, did you birth at home or hospital, are you living in a suburban or rural location and who was your primary carer – a midwife or a doctor (GP or obstetrician), how many carers did you see throughout your pregnancy up until your baby was six weeks old;
• What things went well, particularly in terms of the care that you received during pregnancy, labour, birth and after the birth;
• What things did not go well, and how could they have been done better;
• What do you think about the choices available to women and their families in maternity services in your area and generally across Australia?
• Are these choices sufficient?
• Have you had choices denied to you? What reasons were given for this?
• Did you feel that you had enough information given to you during your pregnancy, labour and birth?
• Were you supported adequately after the birth of your baby? If so, in what ways, and if not, why not?
• What changes would you like to see in maternity services;
• Anything else that you feel you would like to share.
Send it to the review at:
Maternity Services Review
MDP 94
GPO Box 9848
Canberra ACT 2601
Australia
or by email at maternity.services.review@health.gov.au
Please send a copy of your story/submission to your local Federal Member of Parliament and to Maternity Coalition (wilkes@maternitycoalition.org.au).
If you are not sure who your elected representative is, use the “find your electorate” tool at http://www.aph.gov.au/house/members/index.htm or phone the Australian Electoral Commission on 13 23 26.
The closing date is the Friday 31st October 2008 (5pm).
It is important to note the following statement from the Health Department:
“While the Review team will not respond individually to all submissions and comments received, it is intended that these be made publicly available. Unless otherwise indicated in the submission, all submissions will be published on the Department of Health and Ageing website until the end of the 2008-09 financial year. In addition, where submissions focus on the issues relevant to the States and Territories, this information will be forwarded to the relevant jurisdiction(s). Copyright resides with the author(s), not with the Government.”
Useful facts
Here is some useful information you might like to know when writing your submission:
Primary Maternity Care
The World Health Organization defines primary health care as “the principal vehicle for the delivery of health care at the most local level of a country's health system. It is essential health care made accessible at a cost the country and community can afford with methods that are practical, scientifically sound and socially acceptable. Everyone in the community should have access to it, and everyone should be involved in it."
Primary maternity services may be provided in public maternity units, birth centres, in the community or in a combination of these settings. Care includes antenatal, birthing, and postnatal care.
Midwifery Continuity of Care
Continuity of midwifery care means a woman is able to develop a relationship with a midwife to work in partnership for the provision of her care during pregnancy, labour birth and the postnatal period. Whilst there are many ways in which midwifery care may be organised, midwives can function autonomously as primary care providers, and do so with the view to personalising (individualising) care for each woman , providing referral to other health professionals if required. Group practice and team midwifery models providing continuity of care should aim to provide women with access to their primary midwife for most of their care.
Source: Australian College of Midwives’ Position Statement on Continuity of Care, February 2007
http://www.midwives.org.au/AboutUs/ACMPositionStatements/Midwiferycontinuityofcare/tabid/809/Default.aspx
Federal funding of maternity care
Federal, state and territory governments are largely committed to strengthening primary maternity care, using midwifery models of care, but funding arrangements actively obstruct these reforms. Maternity care is not just a state issue.
Hospitals are run by the state, but Medicare, which is federally funded, plays a large role in maternity care. With some specifically-funded exceptions, hospitals tend not to provide comprehensive antenatal or postnatal care (they don't receive funding for it). So women are pushed toward GPs (or private obstetricians) for Medicare-funded antenatal care. Hospitals wanting to set up, e.g. comprehensive ante and postnatal midwife-led programs, such as one-to-one midwifery care, can find themselves unable to fund the extra midwife workload, as midwives are currently not eligible for Medicare rebates. Maternity Coalition proposes two ways that the federal government can assist:
• Bringing midwives onto the Medicare Benefits Schedule. Then ante and postnatal visits with a midwife will be covered by Medicare.
• For each woman who receives her antenatal, birth and postnatal care from a state-run maternity service, to an agreed standard of care, the federal government would pay the state government a set fee (we estimate $500–1000). This money would be passed on to service providers by the state government, and would be in addition to existing funding: therefore hospitals would be receiving sufficient funding to keep their post and antenatal care in-house.
Click here to read Maternity Coalition's federal funding brief, which explains funding issues and our proposed solutions.
Facts and figures
In November 2007 the Australian Institute of Health and Welfare released Australia’s mothers and babies 2005, the 15th annual report on pregnancy and childbirth in Australia. The report is based primarily on the National Perinatal Data Collection.
The following information is from the summary page of the report – you can read the full report here: http://www.aihw.gov.au/publications/per/amb05/amb05.pdf
In 2005, 267,793 women gave birth to 272,419 babies in Australia. There were 15,214 more
births (5.9%) than reported in 2004.
Mothers
Of women who gave birth in 2005:
• the mean age was 29.8 years, continuing the upward trend in maternal age
• 9,867 were of Aboriginal or Torres Strait Islander origin, making up 3.7% of all mothers
• 17.4% reported smoking at all during pregnancy
• 1.7% had a multiple pregnancy
• 58.5% had a spontaneous vaginal birth, 0.4% had a vaginal breech birth, while deliveries
using forceps accounted for 3.5% and vacuum extractions for 7.2%
• 30.3% gave birth by caesarean section, compared with 19.5% in 1996
• who had previously had a caesarean section, 83.2% had a caesarean section in 2005
• the median length of stay in hospital was 3.0 days, and was longer for women who had a
caesarean section (5.0 days).
Babies
Of babies born in 2005:
• 8.1% were preterm (less than 37 weeks gestation)
• 6.4% of liveborn babies were of low birthweight (less than 2,500 grams)
• the national sex ratio was 105.5 male live births per 100 female live births
• 15.5% of liveborn babies were admitted to a special care nursery or neonatal intensive
care unit
• 6,044 were admitted to level III neonatal intensive care units in Australia and met
ANZNN’s high risk criteria, of which 78.0% were preterm
• the fetal death rate was 7.3 per 1,000 births; the neonatal death rate was 3.2 per 1,000 live
births; and the perinatal death rate was 10.5 per 1,000 births.
1. National Maternity Action Plan – Maternity Coalition’s vision
Back in 2002 Maternity Coalition released the National Maternity Action Plan and was the first national blueprint for reform of Australia’s maternity services.
It was put together by pregnant women and mothers who are committed to seeing women have the choice of a known midwife to care for them throughout pregnancy, birth and the first few weeks after the birth.
The right to choose a midwife as her lead carer is available to women in many other OECD countries, but not to women in Australia. It is based on scientific evidence that shows women and babies have very good outcomes from midwife-led care.
The National Maternity Action Plan explains why reform of our maternity services is needed and how women and babies will benefit. Read more about it here.
2. What the politicians are saying
In the lead up to the 2007 election the ALP showed some signs of supporting mums and babies. Below are links to some media releases – it might be useful for us all to point out how the changes we’d like to see would improve care for women with postnatal depression (including better and earlier detection and prevention) as well as to support breastfeeding rates across the country.
ALP Media release: Federal Labor's $85 Million Plan For Postnatal Depression
A Rudd Labor Government, in partnership with the States and Territories, will invest in an $85 million National Plan, over five years, to combat postnatal depression.
http://www.alp.org.au/media/1007/mshealoo060.php
ALP Media Release: Labor Will Support Breastfeeding Mums
Media Statement - 22nd November 2007
A Rudd Labor government will provide increased support for new mums who want to breastfeed.
Labor will provide $2 million over four years to the Australian Breast Feeding Association to set up a national toll free 24 hour phone line.
http://www.alp.org.au/media/1107/msfcsheawom220.php
Inquiry into Breastfeeding and the report ‘The Best Start’
The former Howard Government held an inquiry into breastfeeding and released recommendations in ‘the best start’. Many of the recommendations from this review could be actioned as part of this national maternity review. If midwives can provide continuity of care to expectant and new mums, we will see a corresponding increase in breastfeeding rates across Australia.
http://www.aph.gov.au/House/committee/haa/breastfeeding/index.htm
4. Articles & case studies:
“Maternity services turf wars have not helped women” – Blog on Crikey website by Justine Caines
29 September 2008
http://www.crikey.com.au/Blogs/Croakey/Maternity-services-turf-wars-have-not-helped-women.html
Study in the journal Birth by Dr Sally Tracy & Mark Tracy which found that admission to neonatal intensive care for babies of low-risk women increased after birth at 37 weeks' gestation.
November 2007
http://www3.interscience.wiley.com/journal/118533633/abstract
A study using Australian national data which showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals.
September 2007
http://www.ingentaconnect.com/content/bsc/bir/2007/00000034/00000003/art00002;jsessionid=366q644d9u13k.alexandra
Large review of studies on Cochrane database showing advantages of continuous support for women during childbirth including women being more likely to birth without caesarean, vacuum or forceps, less likely to use pain medications, more likely to be satisfied, and have slightly shorter labours.
Updated Apr 2007
http://www.cochrane.org/reviews/en/ab003766.html
Case study showing successful outcomes for young indigenous mothers through a 2005 NSW Baxter Health award winning midwifery / arts project.
http://www.archi.net.au/e-library/workforce/midwifery/mubali
Study by midwife Dr Sally Tracy in British Journal of Obstetrics and Gynaecology showing that for low risk pregnant women giving birth in small maternity units in Australia is safe.
December 2005
http://www3.interscience.wiley.com/journal/118613179/abstract?CRETRY=1&SRETRY=0
Study of planned home birth for low risk women in North America using certified professional midwives which found lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
June 2005
http://www.bmj.com/cgi/content/abstract/330/7505/1416
Australian study published in showing community-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate.
December 2003
http://www3.interscience.wiley.com/journal/119025535/abstract
Study by midwife Dr Sally Tracy in British Journal of Obstetrics and Gynaecology looking at costs cascade of obstetric intervention
August 2003
http://www.ingentaconnect.com/content/bsc/bjo/2003/00000110/00000008/art00002;jsessionid=1rumg2wscmikl.alexandra?format=print
