5 years ago
NATIONAL CONFERENCE OF THE AUSTRALIAN COLLEGE OF MIDWIVES
CHRIS BOWEN MP
I want to begin by celebrating the fact that we're meeting on Ngunnawal and Ngambri land and pay my respects to elders past, present and emerging. And, of course, as we do so, note that we have a long, long way to go before we eradicate indigenous disadvantage in Australia, including in health, including in child health. And I do want to recognize the work that the college has pioneered in birthing on country, I've seen it firsthand in my tours around remote Australia, it is a good partnership with Merck, and I think it's very valuable and has a lot to contribute to reducing the challenges of indigenous disadvantage in healthy childbirth.
I was keen to accept your invitation and to express my support for the College's work this morning. I do have a soft spot for midwives. I have two children. The obstetrician didn't quite make it to the birth of the second one, he had a personal commitment, which meant he couldn't make it on time. So it was just me and the midwife. We had everything under control. I still got the bill. But the actual delivery was obstetrician free. I'd like to think I played a key role, but I was merely the catcher. The midwife was, of course wonderful.
And I do think it's important to remember that, of course, the last Labor Government understood the role of midwives and added midwives to the national registration scheme, ensuring that regulation is on par with other medical professionals as it should be, and also gave midwives, access to a range of Medicare and PBS items for the first time, and in our national platform committed to expanding the role of midwives by better utilising skills and experience of midwives, which is of course important.
Now, of course, there are plenty of things that we do need to tackle together and I do commit myself in my time in the portfolio, to working closely with the College, to consulting and to listening. Right up front, one of the big barriers is, of course, the saga of professional indemnity. Now, it doesn't affect every single person in this room, but it affects enough for it to receive the attention of all of us. As we speak, the Government is introducing legislation to cover professional indemnity for doctors and for midwives.
Now, we'll look at the details. I haven't seen the details yet. I'll be consulting closely with Luke and with Terry and with all of you and your representatives about that legislation before we make up our minds about it. But as I understand it, as we, from what we have seen, the legislation will not address the two major issues that midwives in private practice have to face.
One is, of course, that there's only one provider for indemnity insurance for midwives, which means there's no competition in the market. And the other is that there's no indemnity insurance at all for home births. And while there's an exemption for holding that insurance, it is set to expire, which of course creates massive uncertainty for midwives in relation to home birth, it can jeopardise the ability of midwives to attend homebirths. Now, I'm not here to pretend to you I have all the answers or that there is any magic solution it has been a problem which has been around for a long, long time. And it's not entirely the fault of this current government. But I do want to say it has my attention. And I would work with the College to try and find practical solutions. The fact that there is only one supplier is a problem. It's not an easy one for government to fix. But it is one that government should play a role in and have attention to fixing. And I look forward to working with your leadership as we do so.
The other matter I want to address is working with a College on continuity of care and continuity of carer models. The college has highlighted to me in my time in the portfolio, the strong evidence that care by a known midwife across pregnancy, birth and postnatal period reduces complications and improves outcomes. And I find that a compelling case.
Now, this is an area which is contested. We do have to acknowledge, ultimately, to me, it's a clinical question based on evidence. The evidence either stacks up, or it doesn't. And it will need to be resolved by constructive conversations between the various sectors. And that takes two to tango. But I know the College is up for it. For my part, it's a simple question. What is the evidence in relation to the best outcomes for women and babies? As simple as that. I'm not here to promote doctors. With all due respect, I'm not here to promote midwives, I'm here to promote better outcomes for patients. That has to be the test. And if it passes the test, it should be done as a clinical question. So I watch this space with interest and where appropriate, I will intervene in the debate. But that's the test I set. And I hope that everybody will come to this conversation in goodwill and good faith to resolve the issues with one objective alone. The best interests of mums and babies.
Now, there's one particular issue that I just want to address. It is important to me, I know it will be important to you and it should be frankly, more important for the country. And this is something that you deal with far too often. As you know, the rate of stillbirth in Australia hasn't moved for two decades. 2200 Australian children die a year. Six a day, stillborn. This devastates families.
I spoke a little bit about this recently. And I have got to tell you, it wasn't particularly easy for me to speak about. I'm one of four boys and only two of us came home from hospital. My mum is 82 now. She still lives it every day. She still mourns my two brothers every single day. And we all do. That's a long time ago.
Things have improved. The way my mom was treated was unspeakable And she can only really speak about it now. The way the medical system treated her. Her bereavement wasn't acknowledged and she wasn't allowed to hold her baby. She wasn't allowed to attend the funeral. She wasn't allowed to name one of them. We've made some progress. Although when I made that speech, I've had people say to me, ' the same thing happened to me not that long ago'.
So while we've made some progress, we certainly have more to do to recognize that a stillbirth is a bereavement, just like every other. Just like every other. Which is why I recently called on the Government to apply the bereavement payment to stillbirth. It currently doesn't. If the baby's born with a heartbeat, the family gets a payment. If the baby's born without a heartbeat. They don't. Of course, no amount of money can deal with grief. But if the system recognizes the cost of a death, then it should recognise the cost of a stillbirth, just the same, that's one small thing we can do.
I read your submission your Colleges submission to stillbirth inquiry, which recently concluded and it's a very good submission. You note, the continuity of care models can halve the stillbirth rate compared to standard care and your advocacy lead directly, I think to the committee's recommendation to develop a national culturally and significant, linguistically appropriate continuity of care model aimed at reducing the rate of stillbirth in Australia. I support that recommendation.
Now the Government's referred it to the Australian Health Ministers Advisory Council. I don't have a problem with that. It should be worked through with state and territory ministers as well. But again, as I said recently, that cannot be an excuse for inaction. This report cannot sit on the shelf and just be forgotten. A nice word said, referring it to the state ministers should simply be a vehicle to get it done. If the Government does it, they'll have a big tick for me, I'll warmly praise them and if they don't do it, they will have a very fierce critic in me, I just want to see this done. I've written to the Labor health ministers asking them to pursue it as a matter of urgency and most, if not all of them, I think have replied to me saying they will. So there is a scope for action. But what I don't want to see I've seen it on too many occasions, a good senate inquiry, good recommendations, nice words said and then we will move on. That can't happen in relation to stillbirth and I'm determined to make sure it doesn't happen in relation to stillbirth.
So again, my main message to you is that you have good leaders who make a good case. I've heard the case. I'm listening to the case. I'm open to further discussions, as we deal with all these issues, whether it is indemnity insurance, whether its continuity of care, whether it is stillbirth. You have a sympathetic and friendly ear in me. I look forward to hearing the views of the College more particularly, and to progressing issues together. And as I said, where the Government listens, they'll have my support and praise and where they don't. They'll have a fierce critic on your behalf. But more than that, on the behalf of the mothers and babies and families that rely on you and the work you do around the country every single day. Thanks for having me here today.
ENDS
I was keen to accept your invitation and to express my support for the College's work this morning. I do have a soft spot for midwives. I have two children. The obstetrician didn't quite make it to the birth of the second one, he had a personal commitment, which meant he couldn't make it on time. So it was just me and the midwife. We had everything under control. I still got the bill. But the actual delivery was obstetrician free. I'd like to think I played a key role, but I was merely the catcher. The midwife was, of course wonderful.
And I do think it's important to remember that, of course, the last Labor Government understood the role of midwives and added midwives to the national registration scheme, ensuring that regulation is on par with other medical professionals as it should be, and also gave midwives, access to a range of Medicare and PBS items for the first time, and in our national platform committed to expanding the role of midwives by better utilising skills and experience of midwives, which is of course important.
Now, of course, there are plenty of things that we do need to tackle together and I do commit myself in my time in the portfolio, to working closely with the College, to consulting and to listening. Right up front, one of the big barriers is, of course, the saga of professional indemnity. Now, it doesn't affect every single person in this room, but it affects enough for it to receive the attention of all of us. As we speak, the Government is introducing legislation to cover professional indemnity for doctors and for midwives.
Now, we'll look at the details. I haven't seen the details yet. I'll be consulting closely with Luke and with Terry and with all of you and your representatives about that legislation before we make up our minds about it. But as I understand it, as we, from what we have seen, the legislation will not address the two major issues that midwives in private practice have to face.
One is, of course, that there's only one provider for indemnity insurance for midwives, which means there's no competition in the market. And the other is that there's no indemnity insurance at all for home births. And while there's an exemption for holding that insurance, it is set to expire, which of course creates massive uncertainty for midwives in relation to home birth, it can jeopardise the ability of midwives to attend homebirths. Now, I'm not here to pretend to you I have all the answers or that there is any magic solution it has been a problem which has been around for a long, long time. And it's not entirely the fault of this current government. But I do want to say it has my attention. And I would work with the College to try and find practical solutions. The fact that there is only one supplier is a problem. It's not an easy one for government to fix. But it is one that government should play a role in and have attention to fixing. And I look forward to working with your leadership as we do so.
The other matter I want to address is working with a College on continuity of care and continuity of carer models. The college has highlighted to me in my time in the portfolio, the strong evidence that care by a known midwife across pregnancy, birth and postnatal period reduces complications and improves outcomes. And I find that a compelling case.
Now, this is an area which is contested. We do have to acknowledge, ultimately, to me, it's a clinical question based on evidence. The evidence either stacks up, or it doesn't. And it will need to be resolved by constructive conversations between the various sectors. And that takes two to tango. But I know the College is up for it. For my part, it's a simple question. What is the evidence in relation to the best outcomes for women and babies? As simple as that. I'm not here to promote doctors. With all due respect, I'm not here to promote midwives, I'm here to promote better outcomes for patients. That has to be the test. And if it passes the test, it should be done as a clinical question. So I watch this space with interest and where appropriate, I will intervene in the debate. But that's the test I set. And I hope that everybody will come to this conversation in goodwill and good faith to resolve the issues with one objective alone. The best interests of mums and babies.
Now, there's one particular issue that I just want to address. It is important to me, I know it will be important to you and it should be frankly, more important for the country. And this is something that you deal with far too often. As you know, the rate of stillbirth in Australia hasn't moved for two decades. 2200 Australian children die a year. Six a day, stillborn. This devastates families.
I spoke a little bit about this recently. And I have got to tell you, it wasn't particularly easy for me to speak about. I'm one of four boys and only two of us came home from hospital. My mum is 82 now. She still lives it every day. She still mourns my two brothers every single day. And we all do. That's a long time ago.
Things have improved. The way my mom was treated was unspeakable And she can only really speak about it now. The way the medical system treated her. Her bereavement wasn't acknowledged and she wasn't allowed to hold her baby. She wasn't allowed to attend the funeral. She wasn't allowed to name one of them. We've made some progress. Although when I made that speech, I've had people say to me, ' the same thing happened to me not that long ago'.
So while we've made some progress, we certainly have more to do to recognize that a stillbirth is a bereavement, just like every other. Just like every other. Which is why I recently called on the Government to apply the bereavement payment to stillbirth. It currently doesn't. If the baby's born with a heartbeat, the family gets a payment. If the baby's born without a heartbeat. They don't. Of course, no amount of money can deal with grief. But if the system recognizes the cost of a death, then it should recognise the cost of a stillbirth, just the same, that's one small thing we can do.
I read your submission your Colleges submission to stillbirth inquiry, which recently concluded and it's a very good submission. You note, the continuity of care models can halve the stillbirth rate compared to standard care and your advocacy lead directly, I think to the committee's recommendation to develop a national culturally and significant, linguistically appropriate continuity of care model aimed at reducing the rate of stillbirth in Australia. I support that recommendation.
Now the Government's referred it to the Australian Health Ministers Advisory Council. I don't have a problem with that. It should be worked through with state and territory ministers as well. But again, as I said recently, that cannot be an excuse for inaction. This report cannot sit on the shelf and just be forgotten. A nice word said, referring it to the state ministers should simply be a vehicle to get it done. If the Government does it, they'll have a big tick for me, I'll warmly praise them and if they don't do it, they will have a very fierce critic in me, I just want to see this done. I've written to the Labor health ministers asking them to pursue it as a matter of urgency and most, if not all of them, I think have replied to me saying they will. So there is a scope for action. But what I don't want to see I've seen it on too many occasions, a good senate inquiry, good recommendations, nice words said and then we will move on. That can't happen in relation to stillbirth and I'm determined to make sure it doesn't happen in relation to stillbirth.
So again, my main message to you is that you have good leaders who make a good case. I've heard the case. I'm listening to the case. I'm open to further discussions, as we deal with all these issues, whether it is indemnity insurance, whether its continuity of care, whether it is stillbirth. You have a sympathetic and friendly ear in me. I look forward to hearing the views of the College more particularly, and to progressing issues together. And as I said, where the Government listens, they'll have my support and praise and where they don't. They'll have a fierce critic on your behalf. But more than that, on the behalf of the mothers and babies and families that rely on you and the work you do around the country every single day. Thanks for having me here today.
ENDS