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The Weekend
Australian
Edition 1 - All-round CountrySAT 15 FEB 2003, Page 027 Into the world in the company of strangers By Claire Harvey Australia could learn from New Zealand's one mum, one medical practitioner ruling, reports Claire Harvey TWENTY doctors, nurses, midwives and obstetricians treated Melbourne woman Katrina Matthews-Flora during her pregnancy. She met most of them only once, did not know half their names and never saw them again, apart from an obstetrician's visit after baby Ethan was born. Across the Tasman, one medical practitioner was responsible for all aspects of Kim Morton's pregnancy. Midwife Rose Martin delivered the baby boy, visited every day after the birth to help Morton begin breastfeeding and was available on her pager 24 hours a day. She will continue visiting Morton for the first six weeks of the baby's life. Both mothers were public patients, but the difference is a New Zealand health system that allows women to choose a single practitioner -- midwife, obstetrician or GP -- to take charge of her pregnancy. New Zealand midwives, who share the same legal status as obstetricians, are in charge of 70 per cent of births. Thirteen per cent of New Zealand babies are born at home -- compared to fewer than 2 per cent in Australia -- and the World Health Organisation has said the Kiwi system is the world's cheapest, safest and most efficient. Australian women cannot consult independent midwives because no insurance companies will provide them with public indemnity cover. The only way to get individual attention during pregnancy is to pay big bucks for a private obstetrician or GP. Meanwhile, the rate of caesareans and medical interventions such as induced births and epidurals is soaring. ``All those services are incredibly expensive -- it's costing up to $4500 for each hospital birth,'' says Sally Tracy of the nursing and midwifery faculty at University of Technology, Sydney. Medicare would save millions if the system allowed women to access one-to-one care from their own midwife in the public maternity system, says Barbara Vernon, president of national consumer group The Maternity Coalition. She and other activists have developed a national maternity action plan, which urges governments to provide free access to independent midwives for all Australian women, in the city or the bush. ``This is about competition and the free market,'' Vernon says. ``New Zealand exposes all areas of the economy to competition, while we prevent midwives from competing to provide care to healthy women. ``There is no other area where normal healthy people consult expert specialists. When you have an earache you don't go straight to a specialist, you see a GP. But in maternity, women get channeled straight into obstetric care without having any medical problem.'' In Australia, breastfeeding rates are falling and there are stories about women having babies at home without the support of a professional, says Alana Street, executive officer of the Australian College of Midwives Incorporated. ``Women and babies are the victims,'' she says. New Zealand midwives have had equal legal status as obstetricians since 1990, when then health minister (now prime minister) Helen Clark made them autonomous medical practitioners. Before that change, fewer than 1 per cent of Kiwi babies were born at home. ``Pregnancy and childbirth are about wellness, not about being sick,'' Norma Campbell of the New Zealand College of Midwives says. ``There has been a huge culture change and it came about because New Zealand women stood up and said they wanted individual care.'' Yet the New Zealand system has its critics. Women in rural areas are forced to stay in hospitals several hours' drive away because of a midwife shortage, and neonatal care in some areas is so scarce that women with very premature babies are sometimes flown to Australia for care. New Zealand obstetrician Alastair Haslam says Australia should be wary of changing its system. He says the growth in midwifery has resulted in GPs abandoning maternity care. Haslam, chairman of the New Zealand committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, says driving GPs out of maternity care would be a disaster for rural Australia. Home birth -- especially when women are a long way from hospital -- is not as safe as hospital birth, says Ted Weaver, chairman of the college's Australian-based maternity committee. ``If women want the system to change it will, but any change has to be safe. And I'm yet to be convinced,'' he says. New Zealand's health system -- where all personal injury lawsuits are dealt with by the government's Accident Compensation Commission -- avoids the massive insurance premiums Australian childbirth workers must pay. In June 2001, Guild Insurance, the only company willing to insure Australian midwives, withdrew its cover, forcing independent midwives to close their doors and find work in hospitals or clinics, or return to nursing. Only 12,000 of the nation's 70,000 registered midwives are working, Street says. While a public patient can still go to a hospital or clinic to consult a midwife, she does not get the individual care of a single practitioner. Matthews-Flora saw a different midwife on every pre-natal visit to Monash Medical Centre's birth clinic and Ethan was delivered by the obstetrician and midwives on duty. ``It was virtually strangers the whole way through,'' she says. |
