Midwifery and Maternal Healthcare

Ms WELLS (Lilley) (18:06): I rise today to support the Medical and Midwife Indemnity Legislation Amendment Bill 2021, because it amends the Medical Indemnity Act 2002 and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 to expand the coverage of professional indemnity insurance schemes to the midwives who are currently excluded.

This bill will open up the Midwife Professional Indemnity Scheme to all endorsed midwives, irrespective of their employment status, and provide access to an insurance policy for this class of midwives that includes intrapartum care. It closes an inexplicable gap in the scheme, so that independent practising midwives can be covered by indemnity insurance. Importantly, this bill will enable midwives working with Aboriginal Community Controlled Health Organisations to be covered for Birthing on Country models of care, which will be an important step forward in improving maternity care for our First Nations communities.

The cumulative effect of the bill's amendments will mean that claims against all privately practising midwives will be eligible under the Commonwealth's medical and midwife indemnity insurance scheme if an eligible indemnity claim is made. Hopefully, fixing this anomaly in the current indemnity scheme will help to attract more midwives to our regional and rural areas, where they are desperately needed, and will improve birthing choices for all Australian women. Empowering women with the option to access independently practising midwives to deliver their babies is so important. It gives them autonomy over their own bodies and the right to make informed decisions about their own health.

I welcome this opportunity to talk about midwifery and maternal health care in Australia. After the birth of my own twins late last year, I received an absolute influx of messages and emails from Northside families and families across the country who were relieved to have a representative who understood the economic and social costs of having a family—particularly a family with multiples. I'm proud to be here today as a voice for them on these issues: on improving our public healthcare system, instead of tearing it down; on expanding extended parental paid leave; on increasing the affordability of child care, making childcare universal and making it the best that it can be; and on tackling the rising cost of living so that families aren't scraping by, living from pay cheque to pay cheque.

In my electorate of Lilley, there is one place where you can give birth to babies, and that is where I gave birth—the North West Private Hospital, which has been helping to welcome new lives into the world for over 30 years. I can vouch for how wonderful the midwives of North West hospital are from my own experiences there, giving birth to Celeste, Ossian and Dashiell. I'll spare the House the gory details of childbirth and the things that midwives have to do. But, really, these people could not be paid enough for what it is that they see, what it is that they do, the counselling that they have to provide, the extended services, and the extended know-how and skills that they bring to what is often a dramatic scene, despite all the best Taylor Swift Spotify playlists you can prepare ahead of time for labour. I think what I experienced with Celeste was being an ordinary mum, living in Chermside and having my first baby, and I could not have felt more supported and cared for than I did with those midwives.

The second time I was at the hospital, also as the member for Lilley, giving birth to twins, at one point, at 4 am, one of the twins had gone down to sleep and the other one was refusing to settle. I was breastfeeding on one side—I hadn't learnt to do it tandem yet—so the midwife had to hand-express the other side so that we could all try to get 45 minutes of sleep before the first twin woke up again. That's part and parcel of being a midwife. She probably did that for about 15 minutes, and then at minute 16 she said, 'While I've got you, can I just talk to you about some workforce issues that we have?' Up to that point she hadn't let on that she even knew I was an elected representative. But she perfectly chose her moment to lobby on behalf of her colleagues for better working conditions for healthcare workers. To be honest, at 4 am, with her helping me to secure 45 minutes of sleep, she could not have found a more receptive audience to that call. God bless midwives.

But I do recognise, in telling this story about midwives at North West Private Hospital, that all of that comes with a certain level of privilege; it is certainly not a universal experience. My hope is that having people like me, with babies, in the parliament will help improve that experience for all mothers across Australia. While our universal healthcare system is arguably one of the greatest achievements of any Australian government, like all public policies it needs to be constantly built upon and constantly reworked as our community evolves. In the Australian public health system, pregnant women must choose either a six-week postnatal attendance by a participating midwife when the baby is six weeks old or a postnatal professional attendance with an obstetrician or a GP. They can't have both. A six-week postnatal attendance by a midwife is $55.05, with an 85 per cent benefit. It includes a comprehensive examination of the mother and baby to ensure normal postnatal recovery and referral of the mother to a GP for the ongoing care of mother and baby. A postnatal professional attendance with an obstetrician or a GP is $73.95 with an 85 per cent benefit. It must include a mental health assessment, must be in a hospital and can occur between four and eight weeks post birth.

Comparatively, an expectant mother in New Zealand can choose a midwife or a specialist doctor to provide maternity care during pregnancy, during labour and up to 46 weeks after the birth. Care from a midwife in New Zealand is free. Services that the midwife or specialist doctor will provide include developing a plan for labour and birth, giving advice on staying healthy during pregnancy, being with them during labour, providing referral to a specialist for support if that is needed, and making hospital or home visits at least five times after the baby is born. When the baby is six weeks old, care is transferred to a Well Child/Tamariki Ora provider. They will get free regular health checks from a nurse until the age of five. They also get assistance in enrolling at a local GP for doctor and practice nurse services.

The New Zealand experience shows us that there is a blueprint for how to roll out effective, comprehensive, compassionate maternal health care—just over the ditch. I implore the Morrison government to take that example and implement it in our own health system. If I have a small grievance about the legislation that we are seeking to amend tonight, it is that it doesn't go further and use this opportunity to do these kinds of things. When we support women in getting the perinatal care that they need, we improve women's health, we support Australian families and ultimately we boost women's participation and re-entry into the workforce. On that note, I would like to use this opportunity to throw my support behind the work of the member for Reid, who presented a petition last year to reinstate the MBS item for abdominoplasty surgery for women who have abdominal separation caused by pregnancy. As a woman who has given birth to three children, including two at once, I know the toll that pregnancy and childbirth can have on both your physical and mental health. One in three Australian mothers experience birth trauma and they sustain physical injuries that they must live with long after they leave hospital, and while caring for a newborn.

Abdominal separation is particularly prevalent in petite women, those carrying multiples, those who have had more than one pregnancy, those who fall pregnant later in life and those who have poor muscle tone or sway-back posture. Abdominal separation in pregnant and post-natal women is first treated through physiotherapy, where the condition may resolve naturally, but evidence has shown that this treatment has limited success in severe cases. Recent studies have shown that abdominoplasty surgery has high success rates for this type of injury, but for many women this life-changing surgery is out of reach because it costs up to 15 grand out of pocket. No woman should have to live with severe abdominal injuries, chronic pain and incontinence after they give birth—particularly because they can't afford surgery. I join the member for Reid and the Australian Society of Plastic Surgeons in calling on the Morrison government to relist abdominoplasty as a Medicare item, to restore the dignity and quality of life for women living with birth trauma.

Unfortunately, fixing issues in the health system is not something that the Liberal and National parties are known for. Consecutive Liberal-National governments have worked consistently to break down our public health system, trying to dismantle Medicare and make Australians pay more, out of pocket, for their health care. In 1983 the Liberal and National parties opposed Medicare, claiming it would bankrupt our nation. They went on to four elections—in 1984, in 1987, in 1990 and in 1993—promising to dismantle it if they were elected to government. In 2013 the Liberal-National government floated the idea of a $4 tax to visit your GP. In 2014 they cut $1.7 billion from Medicare. They proposed a $7 tax to visit your GP while cutting company tax by 1.5 percentage points. In 2015 they cut almost $1 billion and continued to pursue the privatisation of Medicare.

In 2021, amid a pandemic, the Liberal-National government snuck in almost 1,000 changes to the Medicare Benefits Schedule. These changes will directly impact the doctors, the nurses and the healthcare workers at the Prince Charles Hospital. With only two weeks until the changes come into practice, we still don't know exactly what rebates are changing. But we do know that the changes include general surgery, cardiothoracic surgery and orthopaedic surgeries, all of which are surgeries that happen at the Prince Charles Hospital every single day. Northsiders in my electorate of Lilley now face the prospect of life-changing surgeries being cancelled at the last minute or risk being left with huge US-style medical bills that they did not expect.

Healthcare costs are spiralling for northside families. In 2013, when the Liberal-National government first came to power, it cost northsiders $27.65 to see their GP. Today it costs $39.35 to see the GP. While real wages growth has flatlined over the past eight years, the Liberal-National government have waved through a 41 per cent increase in the cost of going to see your doctor. Healthcare costs take a huge chunk out of household budgets. Not long ago, I had a constituent named Leonie write to me to say that she went to an eye specialist and had to pay $530 for the appointment and only got $97 back once the Medicare claim was processed. You shouldn't have to wait until payday to book in to see your doctor. Going to see a specialist or a GP should not be a luxury; it should be a basic human right. The only card you should have to pull out at the doctor's office is your Medicare card. It's what generations of people have fought for, to have this as standard practice for Australians today. I will fight to protect Medicare because we know what happens when the health and the safety of Australians is privatised. Just look at our private aged-care system that is in absolute crisis right now.

I also want to use this opportunity, while we're talking about the role of midwives, to talk about stillbirth being a significant mental health issue that does not get the attention and dedicated public policy that it deserves. Every day, six Australian babies are stillborn. This number has remained unchanged since records were first kept, around 20 years ago, while the rate of stillbirth in other countries has dramatically dropped. It is long past time we break the silence and make stillbirth a national health priority. As Senator Keneally explained in the other place, collectively, as a country, we have considered stillbirth too sad to talk about; we have viewed it as a private tragedy rather than a public health problem.

The Senate Select Committee on Stillbirth Research and Education inquiry chaired by Senator McCarthy was the first national inquiry to report on the impact of stillbirth on Australian families and the Australian economy. The recommendations delivered by that inquiry are relatively simple and inexpensive, such as small changes in clinical care and education projected to reduce the stillbirth rate in Australia by 30 per cent. It is imperative to take swift action on the recommendations to reduce the terrible tragedies of lost pregnancy this country, especially those that are stillbirths.

Our communities are already leading the way here. In my electorate of Lilley, Susannah Holmes is a coordinator at Peach Tree Perinatal Wellness, a community organisation which provides educational and support services to expecting and new parents. This is one example of the type of service that saves babies' lives and one example of the type of service we need to see rolled out on a national scale. We must make haste in doing so, because with every day that passes another six babies are being lost to stillbirth. The Australian parents who live with lost pregnancies show some of the greatest courage in our communities, and this parliament should honour them by doing the same and making stillbirths a national public health priority.

With my remaining time, I would pay tribute to the Stillbirth Centre of Research Excellence located at the Mater Hospital in South Brisbane, who are a fabulous group, you would appreciate, of strong fantastic women and some very supportive men who work on stillbirth research in this area and on what needs to be done. They have been rolling out the Safer Baby Bundle across the country since just prior to the pandemic. They do excellent work. They don't get enough credit. They don't get enough funding. They don't get enough support. With my remaining time, I congratulate them on their work and recommit myself to doing what I can to further that cause with my time in this place.