Helen Haines (Indi, Independent) Share this | Hansard source

I want to acknowledge the words from the member for Blair. Thank you so much for stepping us through what has been a long and at times complicated labour in the birth of this incredibly important legislation. As many members of this House know, I am still a registered midwife but no longer a practising midwife. Time honours the brave. Many of us worked long and hard and fought for reforms such as this right back to the 1990s. I remember what the member for Blair was telling us about those reforms that started in 2002 and then legislative changes in 2011. I remember them all and I thank him for his contribution to making those changes then. He also acknowledged Rosemary Bryant, and I remember the work of Rosemary very well.

I am just so pleased—thrilled, actually—to rise to speak to the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Amendment Bill 2024. If that young midwife, back in the nineties, could have possibly thought that she would end up in the parliament on the day when this legislation was being debated, she certainly would not have believed it. Those lovely things that happen from time to time about writing a letter to your younger self—well, this is a letter I don't think I ever would have written.

This is important. This bill will provide a framework which will allow the government to pay 100 per cent of eligible claims for relevant intrapartum services provided outside of a hospital. This aims to ensure professional indemnity insurance coverage for eligible midwives providing home birth services, eligible midwives providing intrapartum care outside of a hospital and eligible entities employing or engaging eligible midwives to provide intrapartum care outside of a hospital, including birth centres, as part of Birthing on Country models of care. These are fantastic models of care that are women centred, parent focused, baby friendly and evidence based.

What that means in practice is that eligible midwives will have access to the financial protection they need to confidently practise the full scope of their skills, to exercise their work away from hospitals in places where women choose to birth and to do that safely and confidently with the full protection of indemnity insurance. Equally, mothers—parents—will now have full confidence in knowing that, in exercising their choice to give birth at home under the professional care of an eligible midwife, they have this insurance coverage. This is really important.

Under current insurance arrangements, there's a significant gap in insurance coverage for midwives to provide intrapartum care outside a hospital, severely limiting access to homebirth and models of care so critical in our First Nations communities, such as the birthing-on-country models of care. The member for Blair outlined very clearly why that was the case: such small numbers of midwives would be unable to collectively contribute to the pool that would be required to get a commercially available insurance product.

This has been a problem for a very long time. Basically, no insurers have been willing to provide the cover for intrapartum care outside a hospital, in part because of the small pool of resources but also because they are unable to accurately quantify risks. This is because homebirth in Australia is very small because of the barriers that we've had to exercising and offering that model of care to women.

This situation has created a very real barrier for women who wish to homebirth and real uncertainty for those midwives who wish to respond to the choices of women. And that's what midwives want to do. They want to provide care that is evidence based, that fulfils their full scope of practice and that is what a woman wants, because if we combine those two things together we know we can get great outcomes. As a result, women were at risk of being transferred to hospital much earlier if they were in a homebirth setting—often much earlier than clinically necessary—and the continuation of culturally safe care and essential birthing on country, because of that, was in jeopardy as well. So we had some unintended consequences, with women having to enter the hospital system much earlier than ever they would have needed to had this insurance been available.

The bill provides scope for rules to be made to specify the intrapartum services covered under the expanded Midwife Professional Indemnity Scheme, the MPIS. The government's broad intent is to cover out-of-hospital intrapartum services where they're provided in compliance with the Nursing and Midwifery Board of Australia's Safety and quality guidelines for privately practising midwives. This bit is really important, because sometimes labours start to get a bit tricky right at the end, right before the baby is born.

There has been some toing and froing in trying to work out the criteria for a homebirth that would be covered by this insurance, and I'm just so pleased that the government have decided to embrace the Nursing and Midwifery Board's safety and quality guidelines, because they lay out very clearly the criteria that are important for a homebirth. It is tried and true and evidence based, and that's what we want. So I'm absolutely delighted about that.

Make no mistake: this change will allow more women and birthing parents greater choice to birth at home with their choice of midwife—and not only at home but with the person they want to have at home. I can't overstate how important this continuity of care is. It is really important that they can do this with the full confidence of knowing that, if on the rare occasion there is an adverse event, they're covered.

All women pregnant with an Aboriginal and Torres Strait Islander baby will have access to culturally safe birthing-on-country services. Deputy Speaker Sharkie, I know you know about this. I know you know what this means to First Nations women in Australia. Eligible midwives will be able to practice, as I said, to their full scope of practice, offering homebirths within the safety net of professional indemnity insurance. As I said, this legislation hasn't been an easy birth, and I want to acknowledge the decades of dedicated work from midwives, consumers, parents across Australia and the fantastic Australian College of Midwives to develop a fit-for-purpose private indemnity insurance product for individually practising midwives.

The Australian College of Midwives has engaged for many years with government and with the Department of Health and Aged Care to seek to contribute to the planning for an insurance solution. They've done this in good faith, they've done it consistently, and they've done it successfully.

I want to acknowledge the efforts of the Chief Nursing and Midwifery Officer, Alison McMillan, for her work in delivering this solution, which ensures public safety without imposing unnecessary restrictions. This is so important.

Of course, I absolutely applaud assistant minister Ged Kearney, the member for Cooper, and I see her fantastic staff over here. I know how much work you've put into this. I know the way that you engage with the people at the centre of the decisions this government is making when it comes to evidence based, safe, affordable, high-quality maternal care. So, thank you so much for your work. You have championed this bill and then shepherded the bill into the House. Women all over Australia, at all stages of their lives—through access to long-acting contraception, to birth, to menopause—benefit from so much of the work of Minister Kearney in this short term of parliament. So, thank you very much to the member of Cooper, the Assistant Minister for Health.

The current insurance exemption will be extended one final time to 31 December 2026, and I know how often midwives hang on this last extension, as we have been doing this for years. Any of them listening, please know: this is the final time, and this is to allow sufficient time to transition to these new arrangements and for regulation and policies to be amended and implemented.

Let me just reflect a little on why this matters. Planned homebirth involves care from midwives, who are registered experts in childbirth, and they want to do so in a woman's home. These registered midwives working privately are often there from conception right through to six weeks postpartum. That familiar face and not having to retell your story are absolutely critical to a birthing woman.

The research is absolutely clear on this. For women with low-risk pregnancies, planned homebirths attended by qualified midwives are safe and satisfying. They set people up for a positive experience of parenting. The research is absolutely clear, and we know that homebirths, when cared for by a highly qualified midwife, do result in less intervention than hospital births. Of course, there are a whole lot of parameters around that, if you want to understand the research in more detail. But it's really clear there's less intervention, and, equally as importantly, the women perceive their experience much more positively.

Midwives provide safe and well-regulated homebirth care, and, as a former midwife, I really welcome this approach by the government to underwrite this insurance. I know this is being celebrated right around Australia, because many women, consumers, dads and midwives have contacted me about this legislation; I've sat down with a lot of them. Many of the mothers actually have shared with me, and we saw this in the New South Wales inquiry into birth trauma, some very deep, personal trauma that they have experienced through previous births. For them, the only way that they can truly feel in control and have a real say in their next birth is to have a homebirth. It empowers them, and it sets them up in a situation that they want to be in.

One woman said, 'Being from a rural area with very limited continuity of care midwifery options, homebirth offers me the right to choose my place of birth and my care provider.' Another one said, 'My home is where I feel safe to give birth.'

I was really pleased to meet with Louise Thornton, a registered midwife with more than 18 years experience—Louise is from Yackandandah in my electorate—along with Rhi from Your Birth Photography and others to talk about how important the reform is to them and so many. I was able to say to them, 'Don't you worry; I'm batting for this big time.'

I want to acknowledge that there is a lot of fear associated with giving birth, and we can mitigate much of it by giving women control over the decisions that affect their bodies. And we know that much of the move of some women to taking choices around freebirth—where there is no professional care—is because of the issues they've had in accessing homebirth. This, again, is a fantastic remedy to address the trauma that many women have experienced and help them to utilise homebirth with a qualified midwife.

In the few minutes I've got left, I also want to recognise the other significant reforms in the roll back of collaborative arrangements and the increased access to PBS listed medicines for endorsed midwives. This is a package that, again, Assistant Minister Kearney has worked so hard on, to make sure that we truly acknowledge that midwives are primary maternity care providers. With the reforms that we're seeing in this legislation and other legislation, we are finally recognising the essential role of the midwife and the need to remove the barriers which stand between the midwife, with their professional expertise, and the women they care for.

As I said, a very long time ago, I worked as a midwife and set up a midwifery group practice with continuity of care under a known midwife. These reforms were part of our fight for achieving choice, control and evidence based care where the woman was at the centre. Back then, many women would have loved to have accessed a homebirth, but they could not—but maybe their grandchildren will be born at home, thanks to this fantastic legislation. It's deeply joyful to now be a member of parliament and speak on this bill.

Finally, I want to acknowledge my Parliamentary Friends of Maternal Health co-chairs, the member for Canberra and the member for Wide Bay, and the work that they do alongside me and alongside many consumers across Australia in continuing to put forward the absolute essential that we get the care of women right—through pregnancy, birth and postpartum—because that's how we set up our nation to be healthy and to live the best possible lives that they can. Start early, start right—this bill really helps us achieve that.

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