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Legislative Assembly for the ACT: 2004 Week 05 Hansard (Wednesday, 5 May 2004) . . Page.. 1759 ..

It was clear to the committee, following the trip to New Zealand, that models of care and place of birth are the most important aspects in defining successful birth outcomes and that radical changes are needed in the ACT system of care. The importance of continuity of care was stressed throughout the inquiry, and the committee considers it important that women have access to continuity of care that leads throughout the antenatal to the postnatal period and offers assistance with establishing breastfeeding and care routines. This is important especially because so many women are isolated from extended families who may have otherwise provided this role.

Women who access the Canberra midwifery program do have access to midwife-led care; however, this program takes a very small proportion of women each year. The committee was told very clearly by women that there should be more midwifery services offered in the ACT. The committee became increasingly concerned that the lack of available midwifery care in the ACT not only reduces choice for women but also can result in less than satisfactory birthing outcomes, and has recommended major systemic changes to the delivery of maternity services. These changes include the Canberra midwifery program being placed under the control of midwives; independent midwives being given admitting rights to hospitals; the operation of delivery wards in the hospitals being changed to ensure greater participation of admitting practitioners; and freeing the midwifery work force to pursue private practice.

The committee recognises that medical advances have greatly improved the health outcomes for at-risk women and babies; however, the more general medicalisation of the culture has come at a cost to women. Current obstetrical practice fails to take a holistic approach and concurrent with the shift to obstetric practice has been the erosion of the status of midwifery practice. The relationship between the higher occurrence of intervention and the obstetric model is also clearly supported by evidence, as is the detrimental effect of unnecessary intervention.

The majority of submissions, including the government submission, raised concerns about intervention rates. I quote the government:

It is generally recognised that reducing the number of interventions low risk women experience during birth improves the health outcomes of women and their babies.

The caesarean rate in the ACT was 21.8 per cent in 2000. It was 18.9 per cent in public hospitals and 29.4 per cent in private hospitals in the ACT. Over half were elective and the rate of caesarean section is increasing. The World Health Organisation considers the caesarean section rate as a key indicator to maternal health outcomes, and considers that a rate over 15 per cent indicates over-utilisation of the procedure. The New South Wales College of Midwives pointed out to the committee that emergency caesarean sections are almost always justified; however, many could have been avoided if the cascade of interventions had not first taken place. That is a very critical point that came through the evidence time and time again.

Given the importance of birth location in successful birthing outcomes, the committee has recommended the establishment of primary birthing units. These units would be off the hospital campuses and have low technology, which has been proved to reduce

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