Recently Federal Health Minister Nicola Roxon announced a review into maternity services. The Minister has given support to considerable maternity reform, particularly the appropriate usage of the midwifery workforce. The discussion paper raises issues such as Medicare funding for midwives, admitting and prescribing rights and indemnity insurance to enable private practice.

So far the consumer voice has not been heard. Instead, media has focussed on the turf war between the medical and midwifery professions. For many years, maternity services, and one could argue health per se, has been about doctors. Interestingly, the use of medical staff, particularly specialists, is not necessary for the majority of women, nor is it supported by evidence.

The vast majority of Australian women will be healthy and experience a normal pregnancy. The majority of women could also give birth normally. Sadly over 30% of women in Australia have their baby removed via surgery. Only 58.5% of women in Australia have a spontaneous vaginal birth. Considering our developed status, this is a telling statistic.

For the best part of 20 years, health policy has been written with a consumer focus, often with language that places the consumer at the centre. In practice this is often not achieved. Within maternity care it is rarely achieved. Australian women do not have choice. Medicare funding channels the majority of women into mainstream medically dominated care. In New Zealand, a baby bonus type health payment enables a pregnant woman to choose a “Lead Maternity Carer”. NZ women can choose a midwife, GP or obstetrician.

The proposed reforms will enable women to choose midwifery care. Considering the currently well-supported options of procedural GP’s and specialists, for the first time Australian women will actually have a choice. Importantly many women may also have the option of giving birth in their local community.

In the last 10 years, more than 120 rural maternity units have closed, causing many women and their families considerable emotional and financial distress. The Howard Government’s refusal to recognise the registered “capacity” of midwives prevented a safe option for at least 75% of women.

As a consumer advocate who has devoted close to 9 years to improving maternity services, I salute Minister Roxon. The Minister has listened to women across Australia. I now hope we see professional groups doing the same. The paternalistic bleating that ‘the safety of a woman and child is paramount’ has worn thin. The truth is the turf war between doctors and midwives has never been in the interests of women or babies. It has been about the protection of the status quo versus an ideological difference in the way services should operate.

Women must be able to choose with who and where they share the intimate act of birth. Enabling all maternity health professionals funding, indemnity insurance and admitting/prescribing rights is long overdue.

With all players participating on a level playing field, women can only benefit. Once reform is realised, I can rest. I have never had an interest in the actual choice women make, just the ability for them to make it. After all a single option of medical care is not choice.

Justine Caines is a mother of seven children aged four weeks to seven years living in rural NSW, and the author of Medical Indemnity in Australia: How one birth changed maternity services. She is a past president of Maternity Coalition Inc, Current Secretary of Homebirth Australia and the founder and convenor of What Women Want (Australia), a political party devoted to advancing women.

Peter Fray

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