What Women Want founder Justine Caines shares her views on the proposed maternity reforms.
Soon after the 2007 election, Federal Health Minister Nicola Roxon announced maternity reform that would enable women to choose a midwife to care for them for their pregnancy, labour, birth and for up to six weeks post-natally. This was to be funded under Medicare. The fantastic part was that it would be one midwife, enabling a woman to form a relationship, knowing who would share her birth experience with her and also provide home based post-natal care. Maternity reform advocates were excited and heralded this as 'landmark'.
Over the last year, however, we've seen intense lobbying from the Australian Medical Association (AMA). Late last year, the proposed reform was altered. Medicare funded midwifery would not go ahead unless a doctor 'signed off' the practices of the midwife, giving an individual doctor veto power over a midwife's practice and woman’s decision making.
Some women will take full advice of their doctor, they are happy with this care. Other women may be clear about their needs. These needs may not fit with a particular doctor's views or philosophies. The woman may want to use deep water for pain relief and even birth. She may not want vaginal examinations. She may not want to be hooked up to a CTG (cardiotocograph) for monitoring, rather agree to intermittent monitoring with a Doppler. She may decide that she does not want to be induced when 'post-dates' as long as both she and the baby are fine. She may want a vaginal birth after a caesarean, she may want to give birth in the comfort of her own home.
These are all valid decisions that a woman needs to be able to make. When a woman makes a decision contrary to medical opinion it is often deemed as 'unsafe' or that she is putting her own experience ahead of her baby’s safety. Yet it is clear that across the world, and the country, there are varying philosophies and medical models that deem what is and isn't safe.
The reforms had the ability to place women as the focus of care, rather than the current practice of meeting the needs of organisations and practitioners first.
The vast majority of maternity reform advocates strongly support a 'networked approach' whereby the woman receives the care she needs by the most appropriate provider. This is possible without removing a woman's right to make decisions about her body and her baby.
Whilst the Australian Medical Association is a powerful lobby group, women on the other hand have no lobby; consumer advocates are unpaid in unfunded community groups. There is a huge power imbalance and the Rudd Government is seemingly willing to erode women's rights due to pressure from the AMA.
The Medicare reform to fund midwives has the ability to establish midwifery care as a mainstream choice for Australian women. Pregnant women could 'hire' a midwife just like they do a GP or obstetrician. For women in rural areas this could mean care in their local community, it could also enable antenatal and post natal care in a woman’s home (if she wishes) or in more convenient locations like community centres.
The reforms had the ability to place women as the focus of care, rather than the current practice of meeting the needs of organisations and practitioners first. Currently many women wait hours for basic care, or experience fragmented care from several providers, often providing conflicting advice and disappointing outcomes.
The approaches and advice in maternity care are nearly as different as the health professionals themselves. This means in one circumstance a woman's needs may be met and not, however, in another. We don’t believe this is a safe way to provide such important care. The interaction between health professionals and women is a two way street, there are 'rights' and 'responsibilities' for each party.
A woman is responsible to demonstrate that she is informed and understands her body and the implications of particular options. A care provider has the right to provide full and open information. They are responsible to be satisfied that a woman understands this information and that it is delivered in a non-threatening way. The woman then has the right to make a decision and be provided with health care of her choosing. This right has been well established in law.
A group of mums from across Australia decided that every woman should have the same decision making rights, together they came up with the idea of delivering a direct message to Prime Minister Kevin Rudd, while he is in Ballarat on February 18. My Body, My baby MY RIGHT to decide was born.
It seems many women agree The Facebook page has taken off with more than 3500 members. Organisers then received messages from across Australia from more women wanting to host local events. There are now 12 other events planned, taking place outside the offices of local federal MPs. The response has been extraordinary. The needs and rights of women are shaping up to be a recurring election theme.
Do you think Australian women should make decisions about their own health care? Chat with Essential Baby members about the issue of maternity reform.