1 Australian Institute of Health and Welfare (AIHW) National Perinatal Statistics Unit, 2008, Australia’s mothers and babies 2006, Perinatal statistics series no. 22, Cat. no. PER 46, Australian Institute of Health and Welfare, Sydney, p. 6.

2 Commonwealth of Australia, 2008, Improving Maternity Services in Australia: A Discussion Paper from the Australian Government, Commonwealth of Australia, Canberra, p. 10, available from http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesreview-discussionpaper

3 Organisation for Economic Co-operation and Development (OECD), 2007, Health at a Glance 2007: OECD Indicators, available from http://titania.sourceoecd.org/vl=21736909/cl=18/nw=1/rpsv/health2007/4-13.html

4 Australian Institute of Family Studies, 2008, Growing up in Australia: the Longitudinal Study of Australian Children: 2006–07 Annual Report, available from http://aifs.org.au/growingup/pubs/ar/ar200607/breastfeeding.html

5 Buist A, & Bilszta J, 2001–2005, The beyondblue National Postnatal Depression Program: Prevention and Early Intervention 2001–2005 (Vol 1 National Screening Program), p. 8, available from www.beyondblue.org.au/index.aspx?link_id=4.665&tmp=FileDownload&fid=348

6 Commonwealth of Australia, 2008, Improving Maternity Services in Australia: A Discussion Paper from the Australian Government, p. 16.

7 Australian Bureau of Statistics, Deaths Australia (ABS Cat. No. 3302.0), [various issues]; ABS Demography Bulletins, (ABS Cat. No. 3102.0), [various issues from 1908], available from http://www.abs.gov.au/

8 AIHW, 2008, Australia’s mothers and babies 2006, p. 49. Maternal deaths are classified into ‘direct deaths’ (deaths from pregnancy complications such as embolisms and obstetric haemorrhage) and ‘indirect deaths’ (deaths from pre-existing diseases exacerbated by pregnancy, such as cardiac disease).

9 Number of maternal deaths, all causes, per 100,000 live births.

10 The ratio of deaths of children within one week of birth (early neonatal deaths) plus fetal deaths of a minimum gestation period of 28 weeks or minimum fetal weight of 1,000 g, expressed per 1,000 births (OECD definition).

11 Organisation for Economic Co-operation and Development, 2008, Health Data 2008. Top of page

12 AIHW, 2008, Australia’s mothers and babies 2006, p. 30.

13 OECD, 2007, Health at a Glance 2007: OECD Indicators.

14 AIHW, 2008, Australia’s mothers and babies 2006, p. 30.

15 Centre for Epidemiology and Research, NSW Department of Health, 2007, New South Wales Mothers and Babies 2005, NSW Public Health Bulletin 2007; 18(S-1), pp. 95–6, available http://www.health.nsw.gov.au/pubs/2007/pdf/mdc05.pdf

16 Submission from the Australian and New Zealand College of Anaesthetists.

17 Submission from the Health Care Consumers Association, ACT.

18 Severe maternal morbidity refers to a range of conditions, primarily related to hypertension, obstetric haemorrhage and severe psychiatric morbidity, which can affect mothers.

19 Submission from the Australian Institute of Health and Welfare, National Perinatal Statistics Unit.

20 Submission from the Stillbirth Foundation Inc.

21 Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GML, Caesarean section for non-medical reasons at term; Cochrane Database of Systematic Reviews 2006, Issue 3., Art. No.:CD004660. DOI:10.1002/14651858.CD004660.pub2

22 Brown HC, Paranjothy S, Dowsell T, Thomas J, Package of care for active management in labour for reducing caesarean section rates in low-risk women; Cochrane Database of Systematic Reviews 2008, Issue 4, Art. No.:CD004907. DOI:10.1002/14651858.CD004907.pub2

23 Submission from the WA Health—Women’s and Newborns Health Network Executive Advisory Group.

24 AIHW, 2008, Australia’s mothers and babies 2006, p. 20.

25 This is collected as the place intended at the time of booking in Victoria, South Australia, Tasmania, or the place intended at the onset of labour in other states.Top of page

26 AIHW, 2008, Australia’s mothers and babies 2006, pp. 20–1.

27 South Australian Department of Health, Pregnancy Outcome in South Australia 2006, South Australian Department of Health, Adelaide, p. 34.

28 AIHW, 2007, Australia’s Mothers and Babies 2005, Canberra, p. 22.

29 United Kingdom Office of National Statistics, 2008, Home Births in the UK, 1955 to 2008, Population Trends 133, available from www.statistics.gov.uk/statbase/Product.asp?vInk=6303

30 New Zealand Information Service, 2007, Report on Maternity Maternal and Newborn Information 2004, p. 64, available from http://www.nzhis.govt.nz/moh.nsf/pagesns/73.

31 National Center for Health Statistics, 2007, National vital statistics reports; Births: Final Data for 2005, vol. 56, no. 6, available from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf

32 Perinatal Data Collection Unit, Victorian Government Department of Human Services, 1999, Report on Models of Antenatal Care, Perinatal Data Collection Unit, Victorian Government Department of Human Services, p. 24.

33 Bruinsma, F; Brown, S; and Darcy, MA, Having a baby in Victoria 1989–2000: women’s views of public and private models of care, Australian and New Zealand Journal of Public Health; vol. 27, no. 1, p. 22.

34 Australian Health Ministers Advisory Council (AHMAC), 2008, Primary Maternity Services in Australia: A Framework for Implementation, p. 9, available from www.ahmac.gov.au

35 AHMAC, 2008, Primary Maternity Services in Australia: A Framework for Implementation, p. 9.

36 Hatem M, Sandall J, Devane D, Soltani H, Gates S, Midwife-led versus other models of care for childbearing women; Cochrane Database of Systematic Reviews 2008, Issue 4, Art. No.:CD004667. DOI:10.1002/14651858.CD004667.pub2

37 Personal submission.Top of page

38 Submission from the Rural Doctors Association of Australia.

39 Submission from the Maternity Coalition.

40 Submission from Homebirth Australia.

41 New Zealand Information Service, 2007, Report on Maternity Maternal and Newborn Information 2004, p. 64.

42 New South Wales Department of Health, Policy Directive, Maternity—Public Homebirth Services, June 2006, http://www.health.nsw.gov.au/policies/pd/2006/pdf/PD2006_045.pdf

43 Kildea S, Polack WE, Barclay L, Making Pregnancy Safer in Australia: The importance of maternal death review, Australian and New Zealand Journal of Obstetrics and Gynaecology, 2008; 48, p.130–6.

44 Australian Institute of Health and Welfare (AIHW), 2005, Rural, regional and remote health-indicators of health, Series 5, AIHW Cat. No. PHE59, Canberra, p. 12.

45 Australian Institute of Health and Welfare (AIHW), 2008, Rural, regional and remote health-indicators of health, Series 9, AIHW Cat. No. PHE97, Canberra, p. 7.

46 Submission from the National Rural Health Alliance.

47 Australian Institute of Health and Welfare (AIHW) National Perinatal Statistics Unit, Australia’s mothers and babies 1991, p. 36, Australia’s mothers and babies 1999, p. 49, Australia’s mothers and babies 2006, p. 39, available at www.aihw.gov.au

48 Personal submission.

49 Submission from the Rural Doctors Association of Victoria.

50 Submission from the Victorian Healthcare Association.

51 Submission from the Women’s Hospitals Australasia.

52 Submission from the Australian and New Zealand College of Anaesthetists. Top of page

53 Submission from Queensland Health.

54 Submission from the Rural Doctors Association of Australia.

55 AIHW, 2008, Australia’s mothers and babies 2006, p. 68.

56 AIHW, 2008, Australia’s mothers and babies 2006, p. 69.

57 AIHW, 2008, Australia’s mothers and babies 2006, p. 53.

58 AIHW, 2008, Australia’s mothers and babies 2006, p. 57.

59 AIHW, 2008, Australia’s mothers and babies 2006, p. 49.

60 AIHW, 2008, Australia’s mothers and babies 2006, p. 19.

61 AIHW, 2008, Australia’s mothers and babies 2006, p. 10.

62 Australian Health Ministers’ Advisory Council (AHMAC), 2008, Aboriginal and Torres Strait Islander Health Performance Framework Report 2008, Australian Health Ministers’ Advisory Council, Canberra, p. 142.

63 AHMAC, 2008. Aboriginal and Torres Strait Islander Health Performance Framework Report 2008, p. 142.

64 Australian Institute of Health and Welfare, 2007. Indigenous mothers and their babies, Australia 2001–2004, AIHW cat. no. PER 38, Perinatal statistics series no. 19, p. 12, available at http://www.aihw.gov.au/publications/per/imatba01-04/imatba01-04.pdf

65 AHMAC, 2008. Aboriginal and Torres Strait Islander Health Performance Framework Report 2008, p. 180.

66 Close the Gap: Indigenous Health Equality Summit: Statement of Intent, 2008, available at http://www.hreoc.gov.au/social_justice/health/statement_intent.html

67 The Close the Gap Steering Committee for Indigenous Health Equity submission recommended ‘that any new strategy in relation to the provision of maternity services to Indigenous women (in the broader context of a national plan of action towards achieving Indigenous health equality by 2030) is developed in partnership with Indigenous Australians and their representatives’.

68 Submission from the Australian Indigenous Doctors’ Association.Top of page

69 Submissions from Charles Darwin Graduate School for Health Practice, the Women’s Hospitals Australasia and the Australian College of Midwives.

70 Participant at the Indigenous Perspectives forum.

71 Submission from the Central Australian Aboriginal Congress Inc.

72 Submission from the Australian Indigenous Doctors’ Association.

73 As reported in the Submission from the Council of Remote Area Nurses of Australia.

74 National Preventative Health Taskforce, Technical Report No 2 Tobacco Control in Australia: making smoking history, 2008, p. 8; Technical Report No 3 Preventing Alcohol-related Harm in Australia: a window of opportunity, 2008, p. 12; Technical Report No 1 ‘Obesity in Australia: a need for urgent action’, 2008, p. 45, available from http://www.preventativehealth.org.au

75 National Health and Medical Research Council (NHMRC), 2003, Food for Health—Dietary Guidelines for Children and Adolescents in Australia incorporating the Infant Feeding Guidelines for Health Workers, Commonwealth of Australia, Canberra, Page 2, available from http://www.nhmrc.gov.au/publications/synopses/dietsyn.html

76 Australian Institute of Family Studies, 2008, Growing up in Australia: the Longitudinal Study of Australian Children: 2006–07 Annual Report, p. available from http://aifs.org.au/growingup/pubs/ar/ar200607/breastfeeding.html

77 Hector D, King L, Webb K & Heywood P, 2005, Factors affecting breastfeeding practices: applying a conceptual framework’, NSW Public Health Bulletin, vol. 16, no. 3–4, pp. 52–55,available from http://www.publish.csiro.au/nid/227/issue/4216.html

78 Amir LH and Donath SM, 2008, Medical Journal of Australia, 189(5) 254–6, available from http://www.mja.com.au/public/issues/189_05_010908/ami11480_fm.html

79 Australian Institute of Family Studies, 2008, Growing up in Australia: the Longitudinal Study of Australian Children: 2006–07 Annual Report.

80 Australian Institute of Family Studies, 2008, Growing up in Australia: the Longitudinal Study of Australian Children: 2006–07 Annual Report.Top of page

81 Australian Institute of Family Studies, 2008, Growing up in Australia: the Longitudinal Study of Australian Children: 2006–07 Annual Report.

82 Guendelman S, Lang Kosa J, Pearl M, Graham S, Goodman J and Kharrazi M, Juggling Work and Breastfeeding: Effects of Maternity Leave and Occupational Characteristics, Pediatrics Vol. 123 No. 1 January 2009, pp. e38–e46, available from http://pediatrics.aappublications.org/cgi/reprint/123/1/e38

83 Buist & Bilszta, The beyondblue National Postnatal Depression Program: Prevention and Early Intervention 2001–2005 (Vol 1 National Screening Program).

84 Caplan HL, Cogill SR, Alexandra H, Mordecai Robson K, Katz R and Kumar R, Maternal depression and the emotional development of the child, British Journal of Psychiatry, 1989, 154: pp. 818–22; Murray L, The impact of postnatal depression on infant development, Journal of Child Psychology and Psychiatry, 1992, 33(3): p. 543–61.

85 AIHW, 2008, Australia’s Mothers and Babies 2006, p. 56.

86 Submission from the Australian Breastfeeding Association.

87 Submission from beyondblue.

88 Submission from the Royal Australian College of General Practitioners.

89 The Clinical Practice Guideline for Perinatal Mortality Audit provides a sound structure and guidance for any health professional to care for a newly bereaved family and is available from www.psanz.org.au

90 Personal submission.

91 Personal submission.

92 Personal submission.Top of page

93 House of Representatives Standing Committee on Health and Ageing, 2007, The Best Start: Report on the Inquiry into the Health Benefits of Breastfeeding, chapter three, available from http://www.aph.gov.au/house/committee/haa/breastfeeding/index.html

94 Australian Government, 2008, Australian Government Response to: The Best Start: Report on the inquiry into the health benefits of breastfeeding. House of Representatives Standing Committee on Health and Ageing’s Inquiry into the Health Benefits of Breastfeeding, Tabled in the House of Representatives, 4 December 2008.

95 Evidenced Based Maternity Care: What It Is and What It Can Achieve, Millbank Memorial Fund, 2008, available from http://www.milbank.org/reports/0809MaternityCare/0809MaternityCare.html

96 The following discussion relies heavily on Risk Perception and Analysis in Australia, Jennifer Cameron and David Ellwood, in Risk and Choice in Maternity Care An International Perspective, Edited by Andrew Symon, Churchill, Livingstone, Elsevier, Sydney, 2006, Chapter 11.

97 Risk and Choice in Maternity Care An International Perspective, Edited by Andrew Symon, 2006, Chapter 11.

98 Dennis C-L, Hodnett E, Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database of Systematic Reviews 2007, Issue 4, Art. No.: CD006116, DOI: 10.1002/14651858.CD006116.pub2

99 Shear MK, and Clayton P, Editorial. Psychiatric Annals, 2008, 3810: p.643–646; Auster, T, Moutier C, Lanouette N, and Zisook S, Bereavement and Depression: Implications for Diagnosis and Treatment, Psychiatric Annals, 2008, 3810: pp. 655–61.

100 Auster et al, Bereavement and Depression: Implications for Diagnosis and Treatment. Psychiatric Annals, 2008, 3810: pp. 655–61.

101 Australian Institute of Health and Welfare (AIHW), 2008, Medical Labour Force 2006, National health labour force series no. 41, Cat. no. HWL 42, additional spreadsheet Specialists and specialists-in-training, table 5.2, Canberra.

102 Health Workforce Queensland and New South Wales Rural Doctors Network, 2008, Medical practice in rural and remote Australia: National Minimum Data Set report as at 30th November 2007, Brisbane: HWQ, p. 9.Top of page

103 Midwife numbers are from Australian Institute of Health and Welfare (AIHW), 2008, Nursing and midwifery labour force 2005, National health labour force series no. 39, Cat. no. HWL 40, Canberra; AIHW, additional spreadsheet Registered nurses—clinical area by selected characteristics, table 2. The Australian rate of midwives was 90.0 per 100,000 population; this is higher than component parts because it includes 526 midwives with an ‘unknown’ remoteness location.

104 Australian Medical Workforce Advisory Committee (AMWAC), 2004, The Specialist Obstetrics and Gynaecology Workforce—An Update 2003–2013, AMWAC Report 2004.2, Sydney, p 35; AIHW, 2008, Nursing and midwifery labour force 2005, National health labour force series no. 39. Cat. no. HWL 40, Canberra: AIHW, additional spreadsheet Registered nurses—clinical area by selected characteristics, table 3.

105 Personal submission.

106 Submission from the Rural Doctors Association of Australia.

107 Submission from Griffith University School of Nursing and Midwifery.

108 Submission from Royal College of Nursing, Australia.

109 Submission from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

110 Australian Institute of Health and Welfare (AIHW), 2008, Australia’s Health 2008, Cat. No. AUS 99. Canberra: AIHW, p. 411.

111 AIHW, 2008, Australia’s Health 2008, p. 342.

112 This is funding for the MBS group ‘obstetrics’, which includes a range of antenatal, labour and delivery and postnatal care items.

113 MBS Item 16400 ANTENATAL CARE—Antenatal service provided by a midwife, nurse or a registered Aboriginal Health Worker if:

    (a) the service is provided on behalf of, and under the supervision of, a medical practitioner;
    (b) the service is provided at, or from, a practice location in a regional, rural or remote area RRMA 3–7;
    (c) the service is not performed in conjunction with another antenatal attendance item (same patient, same practitioner on the same day);
    (d) the service is not provided for an admitted patient of a hospital; and to a maximum of 10 services per pregnancy. Fee: $22.90 Benefit: 85% = $19.50.

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114 As GPs do not record the nature of their consultations for Medicare purposes, we do not know the number of GP standard and long consultations that are devoted to maternity care (generally) or postnatal care (specifically). The AIHW provides a small sense of GP maternity servicing in its General Practice Activity in Australia 2006–07 publication, however, where it suggests that 0.8% of the problems managed by GPs relate to pregnancy matters. This would translate to around 800,000+ GP Medicare consultations per year.

115 It provides an additional rebate to patients for Medicare eligible out of hospital services of 80 per cent of the gap between the fee charged by the doctor and the standard MBS rebate, once the person has passed the appropriate threshold. In 2009, singles and families qualify once their out of pocket costs on out of hospital services exceeds $1,111.60, or $555.70 in a calendar year for concession card holders and recipients of Family Tax Benefit (Part A) payments. Most families having their second or subsequent child would be in receipt of FTB(A) payments, and therefore would qualify once their out of pocket costs on out of hospital services exceeds $555.70.

116 National Health Care Agreement, 2009, available from Council of Australian Governments (COAG) website: http://www.coag.gov.au/ 2009

117 Personal submission.

118 Submission from the Australian Medical Association.

119 National Registration and Accreditation Scheme for the Health Professions, 2008, Consultation Paper: Proposed Registration Arrangements, Issued by the Practitioner Regulation Subcommittee, Health Workforce Principal Committee, Australian Health Ministers’ Advisory Council, 19 September 2008, available at www.nhwt.gov.au

120 National Registration and Accreditation Scheme for the Health Professions, 2008, Consultation Paper: Proposed Registration Arrangements, Issued by the Practitioner Regulation Subcommittee, Health Workforce Principal Committee, Australian Health Ministers’ Advisory Council, 19 September 2008, available at www.nhwt.gov.auTop of page