Protect birthing choices for Australian women through funding reform

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Australia’s maternity system is in crisis.

Australian women’s basic human right to give birth where and with who they choose is under threat.

The issues:

1.     Australian women face limited affordable options for their pregnancy, birth and postnatal care. Only 8% of women experience continuity of care with a known care provider, which is known to improve outcomes for mothers and babies (1). Rural maternity facilities are being de-funded and are closing at an alarming rate, leaving some women no choice but to drive hundreds of kilometres to get to a hospital. Indigenous women lack accessibility to give birth on country.
One third of women experience birth trauma (2) and somewhere between 1/5 and 1/8 of women leave birth with post-traumatic stress disorder (3). These women are traumatised by the care they are receiving in our broken maternity system.

2.     The current maternity funding model is not structured in a way that allows funds to be appropriately allocated. It does not recognise additional services being provided by care providers (e.g. being on call, consultations via phone/skype, case review, pathology review, diagnostics etc.). It is difficult for hospitals to manage, reduces financial flexibility, reduces standardisation of evidence-based care and leads to higher costs and worsened patient outcomes (4). Many women who would choose to birth in a different environment or with different care providers are unable to do so due to restricted funding. This only adds to these negative birth experiences.

3.     Australian Law requires care providers to have Professional Indemnity Insurance. Currently, no such insurance product exists for Privately Practising Midwives, so the government has allowed an exemption until the 31st of December this year.
If the exemption isn’t extended, or if an insurance product is not made available, homebirth in Australia will become illegal, and from March 2019 there will be pregnant women who are at risk of not being able to birth at home. This is an emergency.
Taking away women’s ability to birth at home with a midwife will result in more women choosing to freebirth with no medically trained staff present.

The proposed solutions:

1.     Continuity of midwifery carer

Midwife-led continuity of care models demonstrate a number of benefits to women with no adverse effects. These benefits include a reduction in childbirth interventions, an increase in spontaneous vaginal births for women of low and increased risk (5) and a reduction in rates of caesarean sections in women of low risk (6). This model of care also demonstrates increased satisfaction for women when compared to other models of maternity care (7).

By redirecting the funds allocated to Australian women for their antenatal, birth and postnatal care into their control, they can choose the model of care and care providers that are right for them (e.g. continuity of care with a midwife). By putting the choice in women’s hands, access to care options and affordability of those services will improve.

It could potentially reduce birth trauma, increase access to care services, increase the utilisation of care services, and consequently increase women’s sense of satisfaction and control with their pregnancy, birth and postnatal experiences.

It would also protect rural birthing services by ensuring that funding is allocated appropriately for any of the care that they provide.

2.     Bundled funding reform

Through these reforms, funding would be made easier for hospitals to manage, would allow financial flexibility (encouraging improved models of care and greater standardisation of evidence-based care), drive better service delivery and consequently lead to better patient outcomes and lower costs.

The Independent Hospital Pricing Authority also states, “There is potential to better align pricing incentives across settings by introducing bundled pricing approaches” (8).

3.     Extension to PII exemption

Right now, the immediate need is for an extension to the homebirth insurance exemption. Until a suitable insurance product becomes available for privately practicing midwives, this is the only solution available.

The National Strategic Approach to Maternity Services process is an absolute joke.

Mothers and consumer groups from around the country have attended consultations and made their desire for bundled funding reform and a solution to the PII issue known, but the final draft document does not mention any of the above issues and proposed solutions.

Politicians are caving in to lobbying pressure from the AMA announcing that the trend towards midwifery care is unsafe and that maternity care must remain obstetric led.

We demand an urgent review of maternity funding model. We demand that the government listens to us – the birthing women of this country - once and for all.

References:

1.     Dawson et al., 2015
Dawson, A.J., Nkowane, A.M. and Whelan, A., 2015. Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review. Human resources for health, 13(1), p.97.

2.     Boorman et al., 2014
Boorman, R.J., Devilly, G.J., Gamble, J., Creedy, D.K. and Fenwick, J., 2014. Childbirth and criteria for traumatic events. Midwifery, 30(2), pp.255-261.

3.     Schwab, Marth and Bergant, 2012;
Schwab, W., Marth, C. and Bergant, A.M., 2012. Post-traumatic stress disorder post partum: the impact of birth on the prevalence of post-traumatic stress disorder (PTSD) in multiparous women. Geburtshilfe und Frauenheilkunde, 72(1), p.56.
Dekel, Stuebe and Dishy, 2017
Dekel, S., Stuebe, C. and Dishy, G., 2017. Childbirth induced posttraumatic stress syndrome: a systematic review of prevalence and risk factors. Frontiers in psychology, 8, p.560.

4.     IHPA, 2015.

5.     Begley et al., 2011; Hartz et al., 2013; Sandall et al., 2015)

6.     McLachlan et al., 2012

7.     Sandall et al., 2015

8.     IHPA, 2015