Maternity Services Review – ‘a good start’

The Federal Government’s review of maternity services has been generally well received by midwives and stakeholders, though questions have been raised about the lack of support for homebirth services.

After working through more than 900 written submissions, and conducting a series of round-table discussions with midwives and key stakeholders, the Maternity Service Review has released its report Improving Maternity Services in Australia.

Led by the Commonwealth Chief Nurse and Midwifery Officer, Rosemary Bryant, the report is the first step in the development of a National Maternity Services Plan.

The review canvassed a range of issues relevant to maternity services, including antenatal services, birthing options, postnatal services, and peer and social support for women in the perinatal period.

The NSWNA supported the NSW Midwives Association’s submission (now the Australian College of Midwives, NSW Branch).

Associate Professor of Midwifery at the University of Western Sydney Hannah Dahlen, also an NSWNA member and national spokesperson for the Australian College of Midwives, said the report contained some very positive recommendations for women and midwives generally, though more work was needed on the issue of providing access to supported homebirth services.

‘There is an unresolved tension in the report where a decision not to allocate Commonwealth funding for homebirth (at least in the short term) is outlined, followed by indications that indemnity-cover for midwives should be addressed but that this will be less likely to be successful for homebirths.

‘This essentially is a dead-end for private midwives providing homebirth services and has the potential to push it even further underground.’

Apart from the homebirth concerns, Professor Dahlen was impressed with the report’s commitment to close the gap on disadvantage for Aboriginal and Torres Strait Islander mothers and babies – in partnership with indigenous people – and improved access for rural women to safe, collaborative maternity care as close as possible to where they live.

Professor Dahlen noted the problems of delivering an effective homebirth model, highlighting the fine line between providing ‘integration, collaboration and support’ for midwives currently removed from mainstream maternity care and the restrictions ‘publicly-funded homebirth models and geographic borders’ would create for midwives already reluctant to work in the mainstream maternity system.

‘The more we … allow midwives to function to the full scope of their role, the better it will be for homebirth as a mainstream option in the future,’ she said, explaining that if homebirth was pushed underground and its skills lost, safety would ultimately be compromised, not improved.

‘In the past 20 years, there have been over 20 maternity reviews at the State and Commonwealth levels, and many of these have not been acted on. Now is the time to stop talking and start acting.

‘We need to all work together to urge the government to listen to the needs of women and their families and make sure that these recommendations are acted upon.’

The ANF has also welcomed the report, which it believes begins to address the barriers to quality care for all mothers and families.

ANF Federal Secretary Ged Kearney said the review’s focus on improving choice for Australian women through the expanded role for midwives showed that the Maternity Services Review had not only ‘understood the needs of women in Australia, but also the professional skills and knowledge available within the midwifery workforce’.

For further details on the Maternity Service Review Report, see Nursing Online on page 45.

Summary of Maternity Service Review recommendations

  1. Improved choice and availability of a range of models through expanded role for midwives; possible changes to Commonwealth funding arrangements; support for professional indemnity insurance for midwives.
  2. New national cross-professional guidelines to be developed to support collaborative multidisciplinary care; and a system for advanced midwifery professional requirements.
  3. Improved national data collections; targeted research to support a safety and quality framework; monitor impact of changing models of care.
  4. Support expansion of collaborative models of care; improved access for rural and indigenous mothers; and reduced workforce pressures.
  5. Assist Australian women’s decision-making by providing better access to comprehensive, reliable information.

For the full report, go to: www.health.gov.au/maternityservicesreview