In 2007, the majority (97.0%) of Australian women gave birth in conventional labour ward settings, with far smaller proportions accessing birth centres (2.2%) or having planned homebirths. There was also a small cohort of women who gave birth before they reached a hospital. Of the women who gave birth in a hospital, 70.2% (196,960 women) were in the public system and 29.8% (83,713 women) were in the private system.19
Continuity of care, as a feature of maternity care, is very important for women. There is an increasing demand for midwifery continuity of care models. There are also many women who choose to access continuity of care from general practitioners (GPs) and specialist obstetricians. It is recognised that these choices should be respected and supported by improved access for those who choose to use them.
The place of birth is a decision for women and their partners and families, with a number of women choosing to give birth at home. There is a continuing demand for planned homebirth to be made available through the public health system,4 resulting in the provision of public homebirth services in several jurisdictions within a safety and quality system. Midwifery Group Practices providing care in the hospital and the community are the usual providers of public homebirth care. Women who choose homebirth also use private models with care provided by a privately practising midwife.
While the overall proportion of homebirths is expected to remain small, demand for homebirth is anticipated to continue.4 Evaluation of individual publicly funded homebirth programs, together with further consideration of the two year National Registration and Accreditation Scheme exemption on the requirement for midwives to hold professional indemnity insurance, will provide an evidence base for further planning decisions.
Providing continuity of care across the entire maternity care continuum requires a collaborative and flexible approach from maternity services and the maternity workforce, supported by integration of services, including:
- effective consultation and referral pathways
- effective clinical networks
- collaborative interdisciplinary professional relationships Top of page
- sound information sharing and communication channels
Transitions from maternity care into child and family health care should also provide continuity of care through a robust system of early referral and information transfer in the postnatal period.37
Some women may experience maternity care that is not well coordinated as they move between:
- public and private systems
- remote, rural, regional and metropolitan locations
- primary, secondary and tertiary levels of care
- different maternity care professionals
Rural and remote servicesThe trend of population and workforce movements to larger centres over the past decade has seen a decline in the number of facilities able to provide full maternity care for women in rural and remote areas. For example, the number of hospitals and birth centres supporting 1–100 births each year declined from 335 facilities in 1992 to 156 facilities in 2007 (Figure 5).13-19
Text from image shown above. Numbers are approximated from the graph shown.
Maternal and perinatal mortality rates are also higher among rural and remote families.4 Achieving sustainable, lower capacity rural and remote maternity services that are networked to higher levels of care for consultation, referral and ongoing management has become a focus of Australian governments in recent years.8 38-42
These services require an appropriately skilled workforce with collaborative networks to secondary and tertiary services, including timely consultation and referral pathways. A key component is providing information technology infrastructure that can improve access to specialist consultation between networked maternity services.
The provision of community-based maternity care in remote locations is also an important strategy for providing care to women in remote parts of Australia. There are outreach programs providing services in parts of Australia;4 however, many women still experience difficulties accessing maternity services near to where they live.
- to provide a standard set of capability requirements for maternity care by public and private maternity services
- to provide a consistent language for health care providers and planners when describing maternity services and planning maternity service developments
While most jurisdictions currently have services capability frameworks (also known as role delineation), AHMAC through HPPPC, has agreed to develop a nationally consistent clinical services capability framework for maternity services, drawing on existing jurisdictional frameworks.Top of page
There has been a shortage of obstetricians, general practitioner obstetricians and general practitioner anaesthetists, particularly in rural and remote Australia, for a considerable period of time. The midwifery workforce is reasonably well distributed on a per capita basis across regional and remote Australia; however, access to midwifery care is affected by distance.
A number of initiatives, backed by significant investments, have been implemented to address current workforce shortages and better equip Australia’s health system, and to meet the growing demand for health services into the future. The November 2008 COAG agreement44 to train more doctors, nurses and allied health professionals included expanded clinical training places for undergraduate medical, nursing and allied health students, additional ongoing GP training places, and additional specialist training places in the private sector.
Further support for the health workforce has been demonstrated by Australian governments in April 20105 through a commitment to training more GPs; more places each year for junior doctors to experience a career in general practice during their postgraduate training period; and training more specialist doctors over the next decade.
The development of direct-entry midwifery courses in many Australian jurisdictions has increased the numbers of midwifery students who, with access to clinical training and experience, will bolster the maternity workforce over the coming years. A number of initiatives have also been designed to encourage retired midwives back into the workforce.
As a result of the Maternity Services Review, the Australian Government is providing financial support for to up to 110 GPs in rural and remote areas for training in anaesthetics or obstetrics through the GP Procedural Training Support Program. The Program aims to improve access to obstetric and anaesthetic services for women living in rural and remote communities.
It will be necessary to ensure all maternity care professionals are utilised to their full scope of practice, and that new, smarter ways of working are introduced to maximise the use of their specialist knowledge and skills.
Total expenditure on maternity services across Australian governments in 2004–05 was $1,672 million.9 This expenditure is mostly associated with hospital births (92% of total funding), with a majority of that funding (70%) attributed to public hospital expenditure.9 State and territory governments fund and develop maternity services in accordance with local policies and planning needs for health services across their state or territory.
Private health insurance also makes a significant funding contribution to maternity services. Private health insurers pay benefits for maternity services for hospital treatment (in-hospital) and general treatment (out-of-hospital). The Australian Government indirectly contributes towards this funding through the Private Health Insurance Rebate.
Hospital treatment benefits provides substantially more funding than general treatment benefits. Statistics concerning the benefits paid for hospital treatment are available from the Hospital Casemix Protocol data collection.
Statistics concerning the benefits paid for general treatment are available from the Private Health Insurance Administration Council (PHIAC). According to PHIAC, private health insurers paid benefits of approximately $1 million in 2008–09 and $800,000 in 2009–10 for maternity services under general treatment. This comprised approximately 9,000 services in 2008–09 and 7,000 services in 2009–10.
Information about new funding arrangements under the Heads Agreement for National Health Reform (COAG, February 2011 and April 2010),5a can be found at page 3 (under Context for the Plan).
States and territories capture a range of detailed data on maternal and perinatal outcomes that forms a national perinatal data collection that is collated by the Australian Institute of Health and Welfare. This data informs systematic reviews at a national level, and allows trends in maternal and perinatal outcomes to be reported.
Jurisdictional data are inconsistently reported in terms of the data and definitions used. The Maternity Services Review4 recommended that consistent, comprehensive national data collection, monitoring and review for maternal and perinatal mortality and morbidity be implemented. This will require data elements with consistent definitions to be used across all jurisdictions. Top of page
a Discussions are continuing with Western Australia to seek their agreement to these reforms. All other state and territories are signatories to the agreement.