Midwifery Indemnity Changes - 17/06/2021

16 June 2021


I rise to speak on the Medical and Midwife Indemnity Legislation Bill 2021. This bill will amend the Medical Indemnity Act and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act. It will expand the coverage of professional indemnity insurance schemes to a group of midwives who, due to gaps in the current legislation, have been excluded unfairly due to their employment status. In Australia, midwives are registered under the Australian Health Practitioners Regulation Agency by the Nursing and Midwifery Board of Australia. Midwives are characterised as either registered or endorsed.

Registered midwives are registered to provide midwifery care only, while endorsed midwives are registered to provide midwifery care and to prescribe medicines. Currently, if you are a midwife in Australia, you have two options when accessing professional indemnity insurance schemes. These are allied health schemes available to registered and endorsed midwives, and the professional midwife scheme, which only covers endorsed midwives. However, both schemes exclude midwives in certain circumstances. If you are a registered midwife who holds insurance through your employment contract, you are ineligible for the allied health scheme. In the professional midwife scheme, if your employer is not also a midwife and the other stakeholders and directors of the company you work for are not midwives, you are excluded. This has particularly impacted midwives working in Aboriginal community controlled health services and has meant that the range and quality of midwifery services being accessed in remote Indigenous communities has been restricted.

The changes made in this bill will be an important step forward in improving maternity care offered to First Nations communities and in closing the gap in outcomes between Indigenous and non-Indigenous mothers and babies. We must continue to do more to ensure that First Nations mothers are fully supported with culturally sensitive support and care throughout their pregnancies.

It is important that all midwives, irrespective of their personal employment contracts, have access to indemnity schemes. This bill will ensure that they do. These amendments bring our legislation into line with the established Commonwealth policy to ensure that claims made against all registered midwives have coverage and that there is parity in the arrangements for all registered allied health professionals. This bill explicitly ensures that all midwives who have previously been excluded will be able to access the scheme regardless of their individual employment status.

Key stakeholders have been advocating this change for a significant period of time. The College of Midwives in particular have been key to ensuring that this change is introduced, and I want to thank them and their members for their hard work in seeing this through. I'd also like to acknowledge the Australian Nursing & Midwifery Foundation, who have supported the implementation of the expanded access for midwives. However, there is still work to be done. Unfortunately, this bill fails to cover homebirths, largely as a result of resistance from insurance companies. I note and welcome the commitment of the minister to continue to work towards homebirth coverage and encourage Australia's medical insurance industry to engage constructively with the government and other stakeholders to ensure that this is achieved.

When it comes to midwifery and birth in Australia, homebirth isn't the only issue that requires more attention from this parliament and legislatures across Australia. I want to talk about continuity of care and the care that we give more generally to mothers here in Australia. These issues became more apparent to me because of two things. One was when I became a mother myself. The other was when I was preselected and then elected. It became apparent to me that these issues are so important to so many people in the community. They talked to me and asked if I would advocate on these issues. The key issues are around choice for mothers. Mothers want some choice, and homebirth is an issue there. Midwives don't have the coverage to enable more women to have that choice if that's what they want. When you're a first-time mother, you are very vulnerable to what you are told and the access to care that you have. In particular, women in First Nations communities, in remote Australia et cetera, are at the hands of whatever is available for them to have that care through pregnancy and birth.

I met with a wonderful group in my electorate called Maternal Health Matters. They were previously called Safe Motherhood. Their goal is for all mothers to have respectful care and safe motherhood. I had never thought about the concept of safe motherhood before. When we have our babies we are quite vulnerable. There is much that can be done to improve the care for women, and midwives are such an important part of that. I want to acknowledge the work that midwives do every day. They come into a moment that is incredibly transitional in the life of a family, not just for the mother but for the partner and baby as well. Midwives deal with what can be an incredibly stressful and challenging—and usually wonderful—situation. I want to thank them.

In particular, I want to acknowledge the midwives at the Canberra Hospital who helped me give birth to my two beautiful babies. When I met with Maternal Health Matters, early on, we talked about the care that mothers receive, particularly the call for continuity of care, which, evidence supports, is the most important thing for a mother to be able to access in terms of their outcome and that of their baby. The evidence points to this as being incredibly important for the health of mother and baby, during and following birth.

Here in Australia we do very well, in terms of mother and infant mortality, with the exception of First Nations communities. But we don't do so well on the comorbidities around motherhood. We have high rates of postnatal depression. Around a third of women describe birth as traumatic. There is a lot more we can do for that. Continuity of care with a known midwife throughout your pregnancy and birth can help a lot. As a relatively recent first-time mother, I can say that to have the same person that you were seeing throughout that pregnancy means so much. For me, that was my GP because I couldn't access the continuous midwife care here in the ACT—simply because it's so popular. So many people want to access that.

In discussing these issues with Maternal Health Matters they said we judge a society by how it treats its most vulnerable. A penny dropped for me: we don't see new mothers as vulnerable in this country. We see babies as vulnerable, not so much mothers. And they absolutely are. This is a huge transition in their lives that can really go either way. It's that support from their community, from doctors but also from midwives, that we could have through this continuity-of-care model.

Many constituents have also written to me about this issue and about a new documentary that's come out, called Birth Time, in which Australian mothers share their journey. I've not yet been able to see this, but I'm going to a screening of it with Maternal Health Matters in July. I hope many in our community will be able to come along to that. It highlights some of the shocking realities that women face, and it shines a light on the unspoken epidemic of postnatal depression. Suicide is the leading cause of maternal death in the developed world. There is more that the federal government can do about this issue, because only eight per cent of Australian women have access to this model of care. I really hope that, as a parliament, this is something we can consider further and work further on. Again, I'd like to acknowledge all the people in my community who've written to me about this issue, the great work that Maternal Health Matters does and the midwives who support new mothers and their babies every day.