Executive Summary (NMAP)

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NATIONAL MATERNITY ACTION PLAN FOR THE
INTRODUCTION OF COMMUNITY MIDWIFERY SERVICES IN
URBAN & REGIONAL AUSTRALIA

EXECUTIVE SUMMARY

The National Maternity Action Plan (NMAP) has been prepared by a broad coalition of consumer and midwifery representatives and organisations from across Australia. The NMAP outlines the rationale behind the need for major reform of maternity services, and, proposes a strategy for Federal and State/Territory governments to enable comprehensive implementation of community midwifery services in both urban and regional/rural Australia within the public health system.

The NMAP calls on both Federal and State/Territory governments to facilitate substantial change to the way in which maternity services are provided, by making available to all women the choice of having a community midwife provide continuous maternity care through the publicly funded health system.

Community midwifery services in the main provide continuity of midwifery led care to healthy women throughout the childbearing continuum, in collaboration with other practitioners such as general practitioners and specialist obstetricians, where indicated. Midwives are able to follow individual women across the interface between community and acute health services and to provide care to each woman from early in her pregnancy until the baby is 4-6 weeks of age.

Universal access to continuity of midwifery care will ensure savings in health dollars and bring Australia into line with international best practice in addition to meeting community demands for a range of readily accessible and appropriate maternity services. Community midwifery is informed by international best practice standards that acknowledge midwives as “the most appropriate and cost effective type of health care provider to be assigned to the care of women in normal pregnancy and birth, including the risk assessment and the recognition of complications” (World Health Organisation, 1999, Care in Normal Birth). In other western countries, particularly in the United Kingdom, New Zealand and Canada, midwifery is promoted and funded both as a public health and a primary health strategy, since community based care from midwives can be responsive to local needs, particularly with regard to health inequalities and social exclusion.

Continuity of midwifery care has been proven to result in fewer women needing expensive obstetric interventions, such as caesarean surgery and operative deliveries. Research also shows that such care contributes to long-term breastfeeding, improved adjustment to parenting, and may lower the incidence of post-natal depression. Widespread access for pregnant women and their families to continuous care provided by community midwives would:

The appropriate role for obstetric specialists lies in the care and treatment of women who develop medical complications during pregnancy or childbirth. Qualified and experienced community midwives should be providing primary care to pregnant women analogous to the role played by GPs in general health care: identifying and referring women to obstetric specialists as needed while providing care to healthy women for the duration of the finite episode of pregnancy and birth. This model involves close and effective collaboration between midwives and obstetricians in the care of women who develop complications. Once the baby is around 4 weeks old, women return to their GP for ongoing primary health care for themselves and their baby.

It is the vision of the consumer and midwifery organisations involved in the development of this National Maternity Action Plan that within the next 5 years there will be equitable access to community midwifery programs providing continuity of care by a known midwife for all women who choose this model of care in all States and Territories.

This paper addresses the following:

RECOMMENDATIONS

To ensure that Australian maternity services are able to meet the diversity and needs of individuals and the broader community in the twenty first century, the national consumer and midwifery organisations involved in preparation of this plan strongly recommend the following:

  1. That Federal and State/Territory governments commit to urgent reform of maternity services with a view to ensuring all pregnant women have the option of accessing primary care from a qualified and registered community midwife throughout the childbearing continuum and within the public health system.
  2. That the Federal Government introduce a Policy on Maternity Service Provision and an Implementation Framework that addresses structural reforms such as funding, legislation, standards of care and indemnification to enable planned and sustainable implementation of community midwifery programs in both urban and regional areas as a matter of priority.
  3. That Federal and State/Territory governments ensure that there is effective consumer representation and participation at both policy and hospital/clinical levels to ensure that consumers of maternity services are included in the decision making processes that directly affect them.
  4. That Federal and State/Territory governments further commit to ongoing expansion of community midwifery services in response to growth in consumer demand for these services.
  5. That the Western Australian Community Midwifery Program, with its emphasis on community management and its provision of one-to-one continuity of midwifery care, be used as a proven and successful template for community midwifery programs to be established in all other States and Territories. Such Programs would ideally offer this type of care to women choosing to give birth in hospital delivery suites, birth centres or in the community.
  6. That Federal and State/Territory governments work cooperatively to identify and eliminate policy and legislative barriers that currently limit or preclude midwives providing evidence-based and cost-effective primary health services to healthy pregnant women and their babies within the public health system.
  7. That the Federal government reviews the Medicare Schedule to include midwives as legitimate experts in the provision of maternity care, and to enable women their right to choose either midwifery or medically led care. Alternatively the Federal Government should implement funding reforms in maternity provision similar to the Lead Maternity Carer arrangements that have been adopted by New Zealand.
  8. That Federal and State/Territory governments implement the necessary legislative changes to enable midwives to order tests and prescribe drug therapy already commonly used in pregnancy, labour and birth.

The National Maternity Action Plan Page 5-7 of 47