Medical and Midwife Indemnity Legislation Amendment Bill 2021

By Matt Keogh MP

16 June 2021

Watch Matt's speech here

It's my privilege to be able to speak on this very important bill, the Medical and Midwife Indemnity Legislation Amendment Bill 2021, before the parliament today. Of course, we're happy to support the outcomes that are sought by this legislation, to make sure that we are extending the availability of insurance arrangements to this very important cohort in our medical and health system across Australia, in particular our midwives.

Ms Kearney: Hear, hear!

Mr KEOGH: I hear the support from the member for Cooper and gratefully receive it, given her great history in that profession and of representing that cohort in our health professions.

As a father of two, I have experienced the great work of midwives in our hospital system, but I'm very well aware—through friends and family who have utilised and sought to utilise midwifery services in a range of different modes—of the importance of making sure that they have that access to midwifery care and that it can be properly insured and made available to as many people as possible.

The member for Canberra was just remarking on continuity of midwifery care. I think this is really important. I've also been contacted about this issue by groups from across our community, including midwives who live in the electorate that I represent and work in the hospitals in and near my electorate. Indeed, some people I knew when I was in high school who are now midwives have raised this issue. Frankly, it was something that I had not thought that much about, even going through the birth of my own children. But, when the issues that relate to continuity of care were presented to me, as well as the better outcomes—not just for the babies but also for the mothers and the entire family—as a result of that different mode of care, it became very clear to me that we need to make sure something is done differently in terms of the funding mechanisms and models for midwifery care to enable and encourage the states, in their delivery of that care, to make sure that families get better outcomes as they go through this critical time.

As the member for Canberra was just remarking, often we can take for granted in 21st-century Australia—especially in our urban centres and cities, where we may be able to live very proximate to great hospitals and healthcare systems—just how dangerous and stressful the entire pregnancy period is, for the mother, for both the parents involved and for the soon-to-be siblings in that changing family environment. We forget how dangerous pending motherhood, pregnancy and childbirth actually are. It's really only very recently in our development that we've been able to take these great leaps forward in our medical care and in the availability and changing modes of midwifery care. We've learnt more about how we used to deliver that care and we've made sure that the modes that were available and have since become unavailable are available again but in a safer environment.

It was dangerous. We lost many mothers through childbirth. There were conditions that simply don't exist anymore or, where they do, we know how to treat properly. We know how to identify the risk factors involved and make sure that different types of care or child birthing procedures are used so that we don't place the mother or the child at risk. They are things that we didn't know 20, 30, 40 or 50 years ago but can pick up on now. If there is continuity of care, we can pick up on them better and we can relieve stress for mothers. We can relieve stress for mothers more by making sure that the way they wish to deliver is available to them and that we can meet families where they are at. That is not just about whether they get to utilise these services in a hospital, a birthing centre or at home but also about remembering that we don't all live next to or near tertiary or secondary hospitals. We should remember that many in our community who are giving birth, as they should quite rightly be able to do, are doing that in remote communities many thousands of kilometres away from the nearest hospital. Making sure that we're able to send out, make available or have locally available that midwifery care is so very important so that people can give birth on country, in their community, so that they can be surrounded by family and their key supports.

Think about the experience of the last 18 months, particularly the middle months of 2020. Many women were giving birth in hospital on their own because others weren't allowed to be in the hospital with them because of COVID. Many in our modern, 21st-century urban society experienced some of the difficulty, stress and anguish experienced by those who have to travel far away from country in order to give birth utilising the improved medical facilities that are available to support families in our cities but often are not available in regional areas, remote areas or on country. We need to make sure that we are able to support those different modes by making sure that there are insurance and indemnities available via the passage of this legislation is vitally important.

More broadly, we need to remember that there are conditions that we are now better able to treat and keep a better monitoring eye on. We continue to think about those in the context of physical ailment, whether it's increased blood pressure or other physiological conditions experienced by pregnant mothers. But it's important to recognise the very important role that continuity of midwifery care can and does play for mental health through being able to pick up and discern minor differences of disposition and demeanour or to ask key questions of an expectant mother, whether they are a first-time mother or this is their fourth or fifth child. It means being able to identify that—hang on!—there is something not quite right, asking key questions and getting them to do the scale test on a regular basis so that stressors on the family and particularly on the expectant mother are identified and that appropriate services are brought in or appropriate referrals are made. It means being ready to catch that family post childbirth so that we can make sure that the right services are available to them where there may be postnatal depression or related issues that can occur.

It's important that we reflect and acknowledge that postnatal depression or postnatal mental health issues or illness are not limited to mothers. They are also experienced by fathers. Whilst there can be stigma associated with any sort of depression, it is important to acknowledge here in the parliament that that is not something that fathers should feel stigmatised about. If they feel depressed, if they feel that they are suffering or are not able to cope with the pressures that come with fatherhood, whether it's their first time or their umpteenth time, they should feel able to seek help. They should feel that it's okay to do that. We should better fund those services as well so that entire families are supported, because, as we know in so many walks of life, it's not just the person who may be suffering from mental ill-health but the family, the friends and the support systems around them who may also need support to help them. That's why I am very happy to support this bill.