Tracy Reibel

The National Maternity Action Plan (NMAP) has been prepared by a broad coalition of consumer and midwifery representatives and organisations from across Australia. The NMAP outlines the rationale behind the need for major reform of maternity services, and, proposes a strategy for Federal and State/Territory governments to enable comprehensive implementation of community midwifery services in both urban and regional/rural Australia within the public health system. The NMAP calls on both Federal and State/Territory governments to facilitate substantial change to the way in which maternity services are provided, by making available to all women the choice of having a community midwife provide continuous maternity care through the publicly funded health system. Community midwifery services in the main provide continuity of midwifery led care to healthy women throughout the childbearing continuum, in collaboration with other practitioners such as general practitioners and specialist obstetricians, where indicated. Midwives are able to follow individual women across the interface between community and acute health services and to provide care to each woman from early in her pregnancy until the baby is 4-6 weeks of age. Universal access to continuity of midwifery care will ensure savings in health dollars and bring Australia into line with international best practice in addition to meeting community demands for a range of readily accessible and appropriate maternity services. Community midwifery is informed by international best practice standards that acknowledge midwives as “the most appropriate and cost effective type of health care provider to be assigned to the care of women in normal pregnancy and birth, including the risk assessment and the recognition of complications” (World Health Organisation, 1999, Care in Normal Birth). ). In other western countries, particularly in the United Kingdom, New Zealand and Canada, midwifery is promoted and funded both as a public health and a primary health strategy, since community based care from midwives can be responsive to local needs, particularly with regard to health inequalities and social exclusion. Continuity of midwifery care has been proven to result in fewer women needing expensive obstetric interventions, such as caesarean surgery and operative deliveries. Research also shows that such care contributes to long-term breastfeeding, improved adjustment to parenting, and may lower the incidence of post-natal depression. Widespread access for pregnant women and their families to continuous care provided by community midwives would: • Provide women with care that is as safe as current routine care • Provide women with the choice of a midwife as their lead maternity carer in line with international best practice The National Maternity Action Plan Page 6 of 47 • Improve maternal and infant outcomes • Reduce the need for costly obstetric interventions in childbirth for the majority of pregnant women • Be at least as, if not more cost effective than conventional models of maternity care. The appropriate role for obstetric specialists lies in the care and treatment of women who develop medical complications during pregnancy or childbirth. Qualified and experienced community midwives should be providing primary care to pregnant women analogous to the role played by GPs in general health care: identifying and referring women to obstetric specialists as needed while providing care to healthy women for the duration of the finite episode of pregnancy and birth. This model involves close and effective collaboration between midwives and obstetricians in the care of women who develop complications. Once the baby is around 4 weeks old, women return to their GP for ongoing primary health care for themselves and their baby It is the vision of the consumer and midwifery organisations involved in the development of this National Maternity Action Plan that within the next 5 years there will be equitable access to community midwifery programs providing continuity of care by a known midwife for all women who choose this model of care in all States and Territories. This paper addresses the following: • Reasons why reform of maternity services is urgently required • What community midwifery care provides for women and babies • Details of a successful best practice community midwifery program in Australia and how similar programs can be readily set up in other States and locations • Recommendations to governments regarding implementation of community midwifery programs.