International Midwives Day

Extract from Hansard

Legislative Council
2 May 2001

Sandra Kanck
Deputy Leader Australian Democrats
Member of the Legislative Council

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The Hon. SANDRA KANCK: Saturday 5 May is International Midwives Day. The day will celebrate continuing progress in returning midwifery from a medical base model to one which is community based and one which is focused on pregnancy being a state of wellness and not of illness. Until the 1920s, midwives were considered a separate profession from nursing. Successful attempts by nurses and medical practitioners to increase their spheres of influence resulted in community midwives losing their autonomy. The opportunity for midwives to once again be recognised as a profession separate from nursing came in 1999 when parliament debated the new Nurses Act but, apart from retaining a separate register for midwives, this parliament unwisely rejected that opportunity.

In nearly every industrial country midwifery is an independent profession with its own registration board. The World Health Organisation views midwifery and nursing as two distinct professions. Over a period of six years I have come to know midwives as the most proactive and passionate group of professional people with whom I have worked in my time as an MP. Despite being hampered from time to time by the narrow minds of the medical establishment, nursing bodies and an out of touch health bureaucracy, midwives in this state have continued to advocate for best practice models which bring the emphasis of maternity services back to women. One exciting development is the new Bachelor of Midwifery course to be offered at both the University of South Australia and Flinders University.

The non-medical model of child birth provides continuity of care and continuity with the same carer throughout pregnancy and birthing to the benefit of both the mother and the baby. Pregnancy and child birth are normal for women and medical intervention ought only occur for the small percentage of cases that are abnormal. In developed countries, the medical model for delivering babies has resulted in high caesarean rates and intervention rates, well above the World Health Organisation's recommendation to not exceed 15 per cent. South Australia in particular has the nation's highest caesarean rate, which in 1996 was around 24 per cent. Queen Elizabeth Hospital, with the caesarean rate of 16 per cent-the best in the state-has had its maternity services slowly but surely eroded away by the present government.

This same lack of government funding and policy commitment has eroded birth choices for women in rural and regional areas. If maternity services have been undermined for white Australian women, then they are almost non-existent for indigenous women. A midwife who has recently spent two months working in Alice Springs was mortified at the quality of service offered to our most vulnerable women. Overseas trained male doctors from countries where it is culturally inappropriate to care for birthing women are treating Aboriginal women who also deem birthing to be women's business. These doctors were uncomfortable in even examining the women and preferred to consult with the women's male relatives rather than the women themselves.

Midwives are leading the charge for appropriate peri-natal treatment by advocating for intakes of Aboriginal women to the new midwifery degree courses. Currently there are no Aboriginal midwives practising in South Australia. The northern community midwifery project is also a shining example of women focused maternity services. That project has demonstrated how a publicly funded continuity of midwifery care model can work within a community based service model. It has operated for the past 2½ years and has offered a service to the socially and economically disadvantaged in our community, in particular indigenous women. Despite its success, its future remains uncertain because there is no further guaranteed funding.

I understand that the Women's and Children's Hospital is about to embark on a midwifery case load model, which has a midwife allocated to a group of women in a continuity of care model-another positive step forward. Although these changes are happening, midwifery still needs to be recognised as a separate profession. The new midwifery degree will produce graduates who will not fit into the current registration model for nurses because, quite simply, they will not be nurses. We as legislators will be forced to confront this.

Midwives are driving change from the bottom up and are changing community attitudes and expectations. Midwifery lost its professional voice by an act of parliament in the 1920s- parliament can restore it.