My letter to Minister...
The Hon. Senator Kay Patterson
Minister for Health & Ageing
Parliament House
CANBERRA ACT 2600
Dear Minister,
Re National summit on health professional indemnity insurance
I am writing to you as a woman in the midst of her reproductive years and as
a voter. I am also writing as a midwife and academic. I request that in
your role, as an elected 'representative of the people', that you reconsider
your representation of stakeholders at the upcoming National Summit on
Professional Indemnity (PI) Insurance to be held on 23 April 2002 in
Canberra.
I am very concerned that you do not seem to hold important the lose of PI
insurance for midwives. Are you aware that this has implications on
childbearing women and their ability to choose and access quality maternity
services? There have been many senate inquiries and research reports that
show midwifery-led care is just as safe if not safer than obstetric-led care
for low risk women (The World Health Organisation state that 'low-risk'
includes > 85% of all childbearing women). Given the bias of media coverage
in regards to the safety of these two forms of care you would be forgiven
for thinking otherwise. There is no evidence that care for pregnant women
can be improved by increasing medicalization of birth
In the face of escalating health costs midwifery-led care is also shown to
be more cost effective. Consider the difference in costs, in terms of
maternal and neonatal morbidity, length of stay in hospital and use of
resources, between an operative delivery (caesarean section, vacuum
extraction, forceps delivery) and a spontaneous vaginal birth. Consider the
cost of a midwife's service to the health care system versus the cost of an
obstetrician's services when providing lead care for low-risk women (vast
majority of clients). Consider that (generally) more midwives 'deliver'
babies than doctors in the public health system and that the public system
has a much lower operative delivery rate than that of private hospitals,
where only doctors deliver babies. Consider that there is no reported
difference in maternal and neonatal outcomes between private and public
hospitals. In addition, be aware that qualitative research reports women's
increased satisfaction with midwifery led-care. (I have listed relevant
reports and a number of websites that would be helpful to your staff should
you request them to provide you with a brief on these issues.) It is for
these reasons women should be permitted the choice of accessing a midwife to
lead their maternity care. If this is to be possible midwives must also have
the issue of PI resolved.
Senator, this insurance issue is much larger than the impact on obstetrical
services alone. Without inclusion of relevant stakeholders such as
childbearing women and midwives I hold little hope of women's needs being
fully realized or met. I am concerned that any solution without these
representatives will only meet the needs of the dominant profession. This
means that women may continue to bear the cost of unworkable solutions by
* Having no choice but be subjected to unnecessary major
abdominal surgery to birth their babies (at great cost to the tax payer and
health care insurers).
* Having the option of midwifery -led services excluded from
their choices, although it is shown through research to be 'best practice'
for low risk women.
* Not having the beauty and empowerment of their baby's birth
being truly recognized nor realized.
Please do not underestimate the importance of this issue to Australian
women. Mothers, grandmothers, sisters, aunts and friends alike watch these
proceedings closely.
In short if you wish to do the best you possibly can for the women you serve
please use your power to include childbearing women's consumer groups and
midwifery representatives in the National Summit. Please place the PI
insurance for midwives on the Summit's agenda.
Yours most sincerely,
Jacqueline Doolan RM RN BN M Soc Sc (Health).
22nd April 2002
CC Meg Lees Democrat Health Spokesperson,
Stephen Smith Labor Heatlh Spokesperson,
Research Reports and Enquiry Findings
(NHMRC = National Health Medical Research Council)
1. ACT Maternity Services Review 1993
2. NSW Shearman Report 1989
3. Victoria Having a baby in Victoria 1990
4. WA Select Committee on Intervention in
Childbirth 1995
5. NHMRC Options for effective care in childbirth
1996
6. NHMRC. Review of services offered by midwives 1998
7. Senate Community Rocking the Cradle (A Report into
Childbirth Affairs References Procedures) 1999
8. King Edward Memorial Hospital Senate Enquiry 2001
Websites of Interest
I have attached research findings and World Health Organisation websites
here.
http://bmj.com/cgi/reprint/321/7254/137.pdf
<http://www.abc.net.au/science/news/stories/s411624.htm>
<http://www.who.int/reproductive-health/pages_resources/listing_maternal_new
born.en.html>
go to 'Care in normal birth'
http://www.fons.org/networks/ebm/guidesm.pdf
Cheers,
Jackie Doolan
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