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Legislative Assembly for the ACT: 2001 Week 8 Hansard (8 August) . . Page.. 2545 ..

MS TUCKER (continuing):

Among the areas for action, we read:

To make sure our health resources are used in the best way possible, we will make explicit choices of priorities in health care, based on scientific evidence ...

Primary health care supports people to manage their own care and assists in maximising their independence.

The World Health Organisation has shown that the best birth outcomes are achieved when a woman's prenatal and postnatal care and attendance during birth are undertaken by a known midwife. This is known as continuity of carer. The importance of this care has also been recognised by at least six inquiries at state and federal levels, with little or no action taken on recommendations made.

The Canberra midwifery program provides care closest to this care. However, the Canberra midwifery program cannot guarantee continuity of carer, even though it aims for this. Women are cared for by a team of midwives. It is hoped that a woman will meet with all midwives on the team throughout her pregnancy, but when she arrives at the birth centre it is quite possible she will be cared for by a midwife she hardly knows.

According to the ACT maternal and perinatal tables 1997, the most recent available, the birth centre contributes only 7.9 per cent of total births in the ACT. The Canberra midwifery program, because of a lack of resources, currently turns away between eight and 14 women per month that seek midwife-based care. This is contrary to recommendations made in 1997, when the community midwives pilot project was evaluated.

Recommendations were that one small team of midwives employing the continuity of care model should become an option for all women in ACT maternity services, that all women should be assured continuity of carer from known midwives throughout the entire maternity period and that future community midwife programs should give women the right to choose the place of birth.

State health departments are propping up an extremely costly medicalised maternity system in terms of dollars and customer satisfaction. Despite our maternity services being medically led, Australian perinatal death rates and premature birth rates are not as good as those in countries such as New Zealand, where healthy women are mostly cared for by midwives.

New Zealand has recognised the importance of midwife-based care. They provide women with a birth payment that enables them to contract the services of their choice. Seventy per cent of women in New Zealand are now choosing a midwifery only service. That is from the New Zealand Health Funding Authority reference document "Maternity Services" dated November 2000.

In Australia the only state government that has recognised the benefit of supporting a midwifery-led service is Western Australia, and the results from the WA community midwifery practice are stunning: lower rates of caesarean section and instrumental births and higher rates of breastfeeding in the first evaluation. They are going from strength to strength.

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