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A History of Community Midwifery Funding in the ACT

Backsliding in Oz

As the following letter points out, Australian birth activists are struggling hard to prevent medicos from using their influence over regional Governments to spike a Federal program designed to broaden choice in childbirth.

Dr Carmen Lawrence
Parliament House
Canberra

Dear Dr Lawrence,

Alternative Birthing Services Program (ABSP)

We are writing to you as representatives of AIMS Australia Inc, BACUP (Birth After Caesarean - Unlimited Possibilities) and Homebirth Canberra Inc on the advisory committee of the Community Midwives Project, which is funded through the Commonwealth's ABSP.

Our purpose is to advise you that we have major concerns about the way in which the ACT Department of Health is proposing to implement the ABSP.

In summary, in 1994 you approved a project proposal by the ACT Government to use ABSP funds to employ midwives to provide antenatal care, support for women during birth in whatever setting they choose, and postnatal care. ACT health consumers supported this proposal.

However, the ACT Department of Health has now indicated that it will revise the proposal to remove the home birth component - in short, "support for women during birth in whatever setting they choose."

If revised, the proposal would be plainly inconsistent with the Commonwealth's purpose in establishing the Program. Moreover, if implemented, the revised proposal would achieve nothing that ACT Health could not achieve with a relocation of existing staff or by using other funding sources.

We consider that you should either require that ACT Health adhere to the original proposal or, alternatively, return to the Commonwealth the ACT's ABSP funding.

The ABSP has a long history.

It was announced in the Commonwealth's 1989-90 Budget, when it was titled The Birthing Services Options. The Women's Budget Statement of 1989-90 (Budget Related Paper No. 6) states that

States will be encouraged to provide a comprehensive range of birthing services and midwife assisted homebirths to supplement the existing hospital programs (p.84).

In supporting the legislation enabling the ABSP, Senator Cook said that

...the Government should take action to provide financial assistance for midwives associated with home births (Hansard, 13 June 1989, p. 3894).

In making this statement Senator Cook was referring to the findings of the 1984 Medicare Benefits Review Committee, to which Homebirth Australia presented a substantial body of evidence.

The ACT's 1989-93 allocation was used to establish a birth centre in the ACT's principal hospital. Women are cared for in the birth centre on a shared care basis by salaried midwives and GPs; they may give birth there or be transferred to the labour ward.

When the ABSP was funded again in 1993 Senator Crowley said:

this program allows women to have the support of a midwife at home if they so choose or to have the baby born in an alternative birthing room in hospitals (Hansard, 30 August 1993, p.472).

The ABSP's Guidelines set out as objectives:

to promote greater choice in birthing for women in the public health system through contributing to the establishment of services which are:

In 1994 ACT Health lodged a submission for funding, proposing, inter alia, to:

employ midwives to provide antenatal care, support for women during her birth in whatever setting she chooses (sic) and postnatal care.

ACT Health was awarded $58,000 per year over four years to implement the ABSP. A press release issued by you on 21 November 1994 announcing the award of the grant stated that

in the ACT funding will be used to employ midwives ... to provide antenatal care, support for women during birth in whatever setting they choose, and postnatal care.

ACT Health has now indicated that the element of choice of place of birth, with the option of home birth, has been discarded. Firstly we were told that this action, which was presented to us as a fait accompli, was necessitated by a lack of support by private medical practitioners. Then we were told that it was due to a lack of necessary "infrastructure" in the ACT.

ACT Health now intends that the ABSP funds will be used to provide midwife/GP shared care for women giving birth in hospital labour wards or the Birthing Centre (located within the maternity section of Woden Valley Hospital).

We have a number of questions about the position being adopted by ACT Health:

All around Australia, medical practitioners have thwarted the implementation of the ABSP's funding for home birth. Senator Crowley has drawn attention in Parliament to AMA obstruction of the ABSP in Western Australia, where funds were to have been used to enable women to engage independent midwives. To circumvent this obstruction, she suggested that

salaried midwives could be appointed to hospitals with the opportunity to work in the hospital and also in the community to assist women to have homebirths if that is their choice. I am very pleased to have the opportunity to assist the women of Australia to be able to make that choice (Hansard, 19 November 1993, p.3284).

This proposal was subsequently considered. WA's medical practitioners threatened to go on strike in the event that it was implemented. The WA Government withdrew the proposal.

We wish to make it plain that ACT Health's proposal to discard the choice of place of birth in its ABSP project does not have the support of ACT health consumers.

We consider that it represents a capitulation to the vested professional interests and prejudices of the local medical profession. It makes a mockery of the consultative processes into which we were invited and in which we happily participated. It obviously undermines the intended purposes of the ABSP and ensures that ACT Health cannot comply with the terms of its funding Agreement with the Commonwealth.

More generally, we consider that the experience of the ABSP Program to date presents you with significant policy challenges:

In the first instance, we ask that you endorse the original proposal, as announced, and so ensure that ACT women can choose where and how to give birth.

We await your early communication on this issue. You may like to telephone Shane Marsh (AIMS) on 247 0110 or leave a message for Kathleen Oldman (BACUP) on 247 0667.

Yours sincerely,

AIMS AUSTRALIA INC.
PO BOX 61
O'CONNOR ACT 2602
BACUP
1 PRELL PLACE
HACKETT ACT 2602

HOMEBIRTH CANBERRA INC.
PO BOX 88
O'CONNOR ACT 2602

6 March 1995


Since the letter was written, ACT Chief Minister Kate Carnell has promised to make available a homebirth option under the Program within 12 months. Don't hold your breath, folks.
For more about homebirth in Australia, read
A History of Community Midwifery Funding in the ACT

To: Midwifery Today - Birth Index - Midwifery information

Last updated 7/23/95 by Donna Dolezal Zelzer, djz@efn.org