Birthing Women in Rural Australia Get A Raw Deal

By Joanne Smethurst


The safety and health of expectant mothers and their babies living in rural and remote Australia is at risk if the Federal Government succeeds in pushing through ante-natal care changes, expected to be implemented this November.

“Tony Abbott’s proposed change to birth care will sentence rural families to a two-tiered health system for years to come,” said Justine Caines, rural mother and policy coordinator for Maternity Coalition.

“Allowing untrained doctors overseeing untrained nurses to provide ante-natal care for women in the bush is unprecedented and is clear evidence of a two-tiered health system. Tony Abbott must immediately reverse this dangerous plan, in order to protect the lives of rural mothers and their babies,” said Ms Caines.

The Federal Health Minister and his department are pushing through a new Medicare item so registered nurses, Aboriginal health workers and even enrolled nurses can do ante-natal checks on behalf of a GP or specialist obstetrician for women in rural and remote Australia. The plan will also allow midwives to provide their skilled and qualified care to expectant mothers.

“The Government’s so-called ‘solution’ is a quick fix as nurses do not have the qualifications nor the necessary skills to provide competent or safe ante-natal care,” said Ms Caines.

“We believe that unskilled care is more dangerous than no care as women are likely to assume their health care is adequate and not seek care from an obstetrician or midwife.

“If anything it will lead to more lives being put at unnecessary risk in the bush.”

“Why is the Federal Government continuing to provide a different level of safety and quality for women in rural Australia compared to the city? Regardless of their address, all Australian women and their babies have a right to expect safe birth care.

“We’re urging rural families to tell their Federal MP and their state’s senators that they cannot accept care from unskilled workers for the sake of their unborn child.”
Who is concerned?
Maternity Coalition, a national maternity consumer group, is concerned about this change. Other professional bodies including the Australian College of Midwives have major concerns about the safety for women if this change is adopted by the government. Nursing organisations are concerned because they realise it will put nurses in difficult situations where they are practising beyond their competencies.
Why are the changes unsafe?
Maternity Coalition is concerned about a range of issues that this proposal raises but its key concern is with the safety of care women will receive under Medicare item 16400:
• Regulatory bodies for nurses and midwives have developed national competency standards. Antenatal care is outside the educational background and scope of practice of all nurses. They have neither the qualifications nor the experience to provide antenatal care to pregnant women. It is dangerous for women to receive antenatal care from a nurse who is being pressured to provide care outside their scope of practice.
• The competency standards for midwives include antenatal care. Midwives are educated for between 18 months and three years in all aspects of maternity care. They are registered or endorsed to provide antenatal care across Australia. Some Aboriginal Health Workers have also obtained an educational qualification in antenatal care.
• Many rural GPs do not themselves have formal education in the provision of antenatal care, except where they have obtained a Diploma in Obstetrics. They are therefore not well placed to assess the skills and competence of nurses who also lack education in this, let alone ‘supervising’ nurses to provide this care.
• There is therefore no guarantee under this policy that rural/remote women will receive antenatal care from someone who is competent to provide it. Unskilled care is more dangerous than no care as women are likely to assume their health is being adequately checked and not seek care from an obstetrician or midwife.
Unsafe practice in practise
In Queensland we have already seen the tragic consequences for a woman being cared for by a non-midwife. A nurse with no midwifery training, working on a post-natal ward, didn't understand the need for women to urinate after having a baby. Because of this, a first-time mother in her mid-20s had to undergo a complete hysterectomy because of this simple omission. The mother will never be able to conceive another child.

If this proposal by the Federal Government gets through, we may see more tragic cases like this where pregnant women develop a pregnancy-related complication and their unskilled ante-natal carer does not realise and does not refer them on to a midwife or specialist obstetrician.
What you can do
Maternity Coalition is campaigning to stop this proposal before its roll-out in November. But we need mothers and families from all over Australia to help.
You could help by:
• Writing a letter to your Federal MP and the Health Minister, Tony Abbott (Tony.Abbott.MP@aph.gov.au)
• Telling your family and friends about the situation.
More information about what you can do to stop this policy is available at www.maternitycoalition.org.au.
Your personal effort could make a big difference as it will show the Federal Government the grass-roots, widespread opposition to this major change to ante-natal care. Even if you won’t be personally affected by this change, it’s important we stand together to ensure ALL birthing women, not just those with a fortunate post-code, get quality and safe birthing care from skilled birth attendants.