PARLIAMENT OF NEW SOUTH WALES

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  4. 25 October 2006

Midwifery Care

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About this Item
SubjectsHealth; Birth; Women
SpeakersSharpe The Hon Penny
BusinessAdjournment


    MIDWIFERY CARE
Page: 3399


    The Hon. PENNY SHARPE [11.34 p.m.]: Tonight I draw to the attention of honourable members the benefits of one-to-one midwifery care for all women who are planning to have a baby. One-to-one midwifery care provides the most effective and supportive care for women before, during and after pregnancy and birth. It should be the minimum standard for all women with normal pregnancies. Pregnancy and birth are a normal part of many women's life cycle. Access to a known midwife who provides continuous care during pregnancy, during labour and post birth has been demonstrated to lower rates of acute medical intervention, including caesareans, epidurals and episiotomies, and provides early intervention that lays the groundwork for a secure start for the mother, her baby and the rest of her family

    One-to-one midwifery care is also very cost effective. Most importantly, midwifery care provides women with continuous, women-centred care that is highly regarded by the women who are able to access it. Every year 250,000 women give birth in Australia. But only 1 per cent of them will access a midwife as their primary carer. Compare this to the situation in New Zealand, where more than 80 per cent of pregnant women receive their primary care from midwives. Unfortunately, the culture of birth in Australia has been overmedicalised. As just one example, the Australian caesarean rate is around 25 per cent. The World Health Organisation believes that it should be no more than 15 per cent. Women in New South Wales who have one-to-one midwifery care typically have a caesarean rate of around 5 per cent to 6 per cent. The main reason for the difference is the type and form of care that women receive from midwives.

    Upon becoming pregnant, most women will first access their general practitioner or an obstetrician to discuss their care and where they will give birth. Few will be offered midwife care, even in cases where it is available. A women who has access to a midwife throughout her pregnancy, labour and birth typically has monthly check ups that last as long as she needs them to. Her needs, wants, fears, ideas and views are sought in relation to her treatment and options for birth. She is provided with as much information that she desires. Her midwife is available 24 hours a day by phone if she has any queries during the pregnancy. Her care is holistic and treats birth not as an illness but as a normal part of life. Midwives build trust and respect during pregnancy so that when the woman is in pre-labour and labour she is informed, confident and ready to allow her body to give birth to her baby. Her midwife is with her for the entire process. If she has received continuous care she is less likely to need pre-labour admission to hospital and is less likely to need drugs during birth.

    Obstetricians and doctors are an essential part of a comprehensive maternity service system, especially for women who have risk factors that require ongoing monitoring and care. However, it is to the detriment of women and babies that the system fails to provide all options of care for women when pregnant. Despite the proven benefits of one-to-one midwifery care, it remains mostly a boutique option due to the lack of a comprehensive national model of maternity care that fully incorporates and prioritises midwifery care into the system. In New South Wales some positive steps have been taken to provide access to primary midwifery care for women. However, this access is not universal.

    I have had the privilege of attending and visiting the RPA birth centre and the Belmont birth centre. Women in Ryde, Camden and the St George area also have access to this sort of care. I am particularly impressed with the St George service that provides a home birth service to women who wish to choose this option. I acknowledge the skilful, caring and hardworking midwives who provide these services. The midwives I have spoken to about the continuous care model report the same things, best summed up by a quote from a report by Carolyn Hastie, who set up and runs the Belmont Birthing Centre. One of the midwives from the service said:

    When I do a home visit, it is so easy, the third day blues don't happen, the babies are not crying, the feeding is going well and the women feel like they have done it by themselves. They feel like they can do anything. We have supported them through it, but they have done it. We are just sitting back enjoying them do it. It is such a joy to watch.

    I hope that as the birthing models in New South Wales further develop the time is not too far away when all women in New South Wales will have access to the benefits, safety and support of one-to-one midwifery care. In the meantime I add my support to the women, midwives and members of the medical community who continue to campaign for the right of all Australian women to access best practice maternity care.

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