Friday, August 14, 2009

The question that was not answered: "Is this an unintended consequence?"

In last week's Senate Community Affairs Committee Inquiry into the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related Bills, the Senators questioned the representatives of the Department of Health and Ageing at length about the homebirth issue.

Senator Siewert asked: "Who looked at the risk to women and their children when women free-birth? There is an acknowledgement that home births will continue without a registered midwife. I find it incredible that we have done all this work but no-one has thought to deal with the risk to women and their children when women free-birth, because they will."

The Department representative agreed.

Senator Boyce asked: "Is this an unintended consequence?"

The response includes a curious batch of 'spin', strung together in 'Yes, Minister' style. For example:
"There are a number of players in this environment. ... under certain conditions and prescriptions ... talking about services they provide and how they fit into the matrix of birthing services ... also about a side-by-side national maternity services plan which is being developed ... a number of streams of activity occurring ... we are acutely aware of the issues ... have been having discussions around these issues ... the minister has been having discussions with stakeholders around those issues. ... I do not think we are at a stage of being able to say more than that."

Senator Boyce: "Most of us have not quite worked out whether we are talking about intended or unintended consequences."

Department again sidesteps the question, and mentions the benefit in the maternity package.

Senator Boyce: "Was the intention to deliberately frustrate the efforts of people to have a midwife attend a home birth or was it unintentional that this has occurred?"

Department again sidesteps the question, and mentions lack of indemnity.

Senator Boyce:
"Nevertheless, that [indemnity] could be actively be [sic] remediated by five o'clock this afternoon if there were a will to do so."

The inquiry continued to delve into what possible reasoning the Department may have had for this consequence - they never found out whether it was intended or unintended. It emerged that although 'qualified assistance' was not to be permitted for homebirth, unregistered persons who were in some way qualified (the meaning of 'qualified' was not defined) could somehow step into the gaping hole left by registered, experienced, qualified, independent midwives who currently attend homebirth.

As if that wasn't enough, the Department's expert on the Act stated: "There is nothing in the scheme that prevents someone from asssisting a person in a birth situation of any kind, whether it is in a clinical setting or in a home-birth situation."
if you are a "registered midwife without indemnity insurance."

It is clear from the discussion and context that this whole mess is not an unintended consequence. As has been documented in this and other blogs and contemporaty publications, the Report of the Maternity Services Review bowed to poweful medical lobbying, without acknowledging the clear conflict of interest, and de-railed the Government's early promise of true reform to maternity services.

Another quotable quote from the Department's spokesperson: "remember that it is draft legislation, not final legislation."

I reckon there's a lot more work to be done!

Post script:
The 1915 individual submissions to the Senate Inquiry are now available for review. Any blog readers who made submissions to the Inquiry, please feel free to tell other readers the number for your submission. Mine is 1592.

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