National Maternity Services Plan

Priority 1 — access

Information about how Australian women and their family members can access maternity care.

Page last updated: 2011

Action 1.1 - Increase access for Australian women and their family members to information that supports their needs for maternity care

(Aligned with Principles 1, 2, 6, 8, 10)

This Plan identifies communication strategies to facilitate women’s awareness of the available information and their options for care. The provision of objective information related to services, and access to it, enables women and their families to make informed choices about their maternity care.4

Several AHMAC-sponsored projects, including the development of National Core Maternity Indicators and National Maternal and Perinatal Mortality and Morbidity Reporting (see Appendix A), will provide access to outcome and indicator information about maternity care.

Further related actions can be found in Actions 2.1.2 and 4.1.5. Top of page

The initial year The middle years The later years Signs of success
1.1.1 The Australian Government expands the National Pregnancy Support Helpline (the Helpline) to provide information, counselling and referral, 24 hours a day, 7 days a week.
The Helpline identifies gaps in the availability of evidence-based information.
The Australian Government sources or develops additional evidence-based information. The Australian Government continues to source or develop additional evidence-based information.
The Helpline ensures that information remains contemporary.
The Australian Government evaluates the Helpline.
Use of the Helpline measured by the number of calls received.
Australian people report satisfaction with the Helpline.
1.1.2 AHMAC identifies objective information resources for women and their families.
AHMAC undertakes a gap analysis of objective information resources for women and their families.
Objective information resources for women and their families are identified and a gap analysis undertaken.
1.1.3 AHMAC endorses the first 10 core maternity indicators.AHMAC endorses the remaining core maternity indicators.
Reporting begins.
AHMAC considers making available nationally consistent and accessible maternity service outcomes and core maternity performance data to inform women and their families.
Reporting continues.
AHMAC agrees and makes available a set of nationally consistent and accessible maternity service outcomes and core maternity performance data.
Women have access to nationally consistent and accessible maternity service outcomes and core maternity

AHMAC = Australian Health Ministers' Advisory Council

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Action 1.2 - Increase access for Australian women and their family members to local maternity care by expanding the range of models of care

(Aligned with Principles 1, 2, 3, 5, 6, 7, 8)

Recent reviews and strategies developed by Australian governments have responded to demand and focused on the need for a range of models of care to be made available to women. Continuing to provide a range of maternity care options, including homebirth, is a priority of the Plan. Continuity of carer, a wellness paradigm, and woman-centred care using primary health care principles have also been identified as important features of maternity care for all women.4 8 36 38-42 55 56

Women's access to safe and high-quality maternity care that accommodates their individual preferences varies by location. Women residing in metropolitan areas generally have greater access to a wider range of models of maternity care compared with women in rural and remote areas.

Women's access to care is improved through the provision of local maternity services. Locally-based care also facilitates the participation of the women’s partners and families in the maternity experience. Services that can be sustained in local settings are particularly important in rural and remote Australia, where women and their families have limited access to the major centres of care. Women in very remote locations may receive care locally through outreach services.

While the provision of local birthing services in remote areas remains challenging, the local provision of antenatal and postnatal care in rural and remote Australia is a priority.57 The provision of antenatal and postnatal care in non-hospital, local settings is critical to improving access to antenatal and postnatal care for all women and their families.

A range of models of maternity care are already available. These include combinations of local obstetricians, anaesthetists, GP obstetricians, GP anaesthetists, midwives, as well as fly-in obstetricians, anaesthetists and midwives. Top of page

All models of maternity care should incorporate robust systems and processes to maximise safety and minimise harm. The safety and quality of locally-provided maternity care is supported through the expansion of care pathways for consultation and referral between local primary services and secondary and tertiary services. Specialist input is facilitated through clinical networking and information technologies, such as videoconferencing, allowing women to access specialised care while remaining in their local communities.

The Australian Government is taking action to increase access by expanding the range of models of care available to women and their families. Access to the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) forms part of the Australian Government’s initiatives for expanding the role of midwives in providing maternity services. This will enable women to access the services provided under the MBS and subsidies for certain medicines prescribed by midwives under the PBS. The provision of a professional indemnity insurance scheme for eligible midwives may facilitate the sustainability of private midwifery-managed models. The extent of the development of practice models, facilitated through these reforms, will be dependent on a range of factors, including the practice choices of individual midwives. The feasibility of any potential business models has yet to be tested.

For MBS items for in-hospital treatment, private health insurers must pay benefits of at least 25% of the MBS fee. For MBS items for out-of-hospital treatment, insurers are not permitted to pay any benefits. Many insurers currently pay benefits for services provided by midwives. Insurers will have to restructure their products to ensure they are compliant with the Private Health Insurance Act 2007 and proposed changes to MBS items, and are obliged to provide reasonable notice to members prior to making changes to benefits, and this period of notice is usually interpreted as 60 days.

Over time, as standards and cost-effective models are developed, it might be possible to expand the number of services available in small communities for women with normal risk factors. Some jurisdictions are exploring options to reinstate safe and sustainable maternity services in some communities where they were previously withdrawn. Top of page

Further related actions can be found in Actions 2.2.3, 3.2, 3.3, 4.2.1 and 4.2.2.

The initial yearThe middle yearsThe later yearsSigns of success
1.2.1 Australian governments facilitate increased access to midwifery-managed models of care for normal risk women, e.g. midwifery group practice or birthing centres, while maintaining support for choice of, and access to, medically managed models of care.
Australian governments facilitate increased access for public patients to midwifery and medical practitioner continuity of carer programs.
Australian governments establish the baseline for the number of women accessing midwifery-managed care.
Australian governments establish the baseline for the number of women accessing continuity of carer programs in each maternity service.
Australian governments evaluate women's access to midwifery-managed and midwifery continuity of carer programs.Increased numbers of normal risk women access midwifery-managed maternity care.
Increased numbers of women access continuity of carer programs.
1.2.2 Jurisdictions develop consistent approaches to the provision of clinical privileges within public maternity services, to enable admitting and practice rights for eligible midwives and medical practitioners.Jurisdictions use best endeavours to facilitate the clinical privileges, admitting and practice rights of eligible midwives.
Jurisdictions monitor the provision of consistent clinical privileges, admitting and practice rights for eligible midwives and medical practitioners.
Jurisdictions evaluate access to clinical privileges, admitting and practice rights for eligible midwives and medical practitioners in maternity services.Eligible midwives have the opportunity to access clinical privileges, admitting and practice rights in public health care settings.
There is a consistent approach to the provision of clinical privileges, admitting and practice rights for eligible midwives and medical practitioners in all jurisdictions.
1.2.3 NMBA endorses a standard for a safety and quality framework, which includes an assessment of clinical risk, for the provision of private homebirth as part of the agreed two-year exemption on the requirement for midwives to hold professional indemnity insurance in order to register as a midwife.
States and territories investigate options for the provision of publicly funded homebirth care.
Health Ministers will review the exemption in 2012.
States and territories consider the implementation of publicly funded homebirth models based on findings of their investigations.
States and territories evaluate publicly funded homebirth programs.Women have increased access to homebirth.
1.2.4 States and territories identify the characteristics of maternity care programs that utilise midwives to their full scope of practice.States and territories consider the implementation of maternity care programs that utilise midwives to their full scope of practice.States and territories evaluate maternity care programs that utilise midwives to their full scope of practice.Increased numbers of midwives are utilised to their full scope of practice.
1.2.5 The Australian Government enables increased availability of private primary maternity services by private maternity professionals through the introduction of MBS and PBS items and professional indemnity insurance for eligible midwives.
The Australian Government undertakes consultations with private health insurers through the peak bodies (AHIA and HIRMAA) to assist insurers to meet their legislative obligations under the Act.
The Australian Government monitors the effectiveness of the introduction of MBS and PBS items and professional indemnity insurance in increasing access for women to local, private primary maternity services.The Australian Government evaluates the effectiveness of the introduction of MBS and PBS items and professional indemnity insurance in increasing access for women to local, private primary maternity services.Women have increased access to local private, primary maternity services in all jurisdictions.
1.2.6 AHMAC identifies the availability of access to public antenatal care in a range of local community settings.
AHMAC considers the inclusion of appropriate data items to measure access to public antenatal care in a range of local community settings in a reporting framework (See Action 1.1.3)
States and territories consider and implement mechanisms to increase access to public antenatal care in local community settings.AHMAC evaluates access to public antenatal care in local community settings.An increased number of women are accessing public antenatal care in local community settings.
1.2.7AHMAC identifies the availability of access to midwifery postnatal care outside hospital settings, to at least two weeks after birth.States and territories consider and implement mechanisms to increase access to midwifery postnatal care, outside hospital settings, to at least two weeks after birth.Women have increased access to midwifery postnatal care, outside hospital settings, for at least two weeks after birth.

AHIA = Australian Health Insurance Alliance
AHMAC = Australian Health Ministers’ Advisory Council
HIRMAA = Health Insurance Restricted Membership Alliance of Australia
MBS = Medicare Benefits Schedule
NMBA = Nursing and Midwifery Board of Australia
PBS = Pharmaceutical Benefits Scheme

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Action 1.3 - Increase access for women and their family members in rural Australia to high quality maternity care

(Aligned with Principles 1, 3, 8, 9)

Access to maternity services for rural women has been affected by population movements and workforce supply in recent years. Specific initiatives to address the implications resulting from these consolidations, such as more limited access to maternity services for women in rural and remote Australia, have included:
  • outreach services, including the Medical Specialist Outreach Assistance Program (MSOAP)
  • rebates for women who must travel to receive care
  • measures to ensure the sustainability of services in rural and remote Australia
Many women in rural and remote Australia who require complex care will continue to travel away from home to receive appropriate care in secondary and tertiary centres. The Plan includes strategies to ensure that women who travel to receive care are cared for within a wellness paradigm that includes their partners and family members.

The Plan includes strategies to ensure the sustainability of primary maternity services, including birthing services, in rural and remote communities and to ensure women can access care in secondary and tertiary services as needed, and are supported by strategic workforce initiatives (see Priority 3 for further discussion of workforce issues). Actions also build on existing initiatives, which will be expanded to include a range of maternity care professionals providing outreach services to rural and remote communities. Tools to inform future planning will underpin maternity service planning and delivery in rural and remote communities (see Action 4.2.1).

Specific issues related to services in remote Australia are addressed in Action 1.4. Top of page

The initial yearThe middle yearsThe later yearsSigns of success
1.3.1 The Australian Government expands MSOAP to include multidisciplinary maternity care teams.The Australian Government evaluates the expansion of MSOAP to include multidisciplinary maternity care teams.
AHMAC identifies the availability of access to state and territory programs of outreach services to rural and remote locations.
The Australian Government considers recommendations arising from the evaluation of the expanded MSOAP.
AHMAC considers mechanisms to expand state and territory programs of outreach services to rural and remote locations.
AHMAC evaluates access to outreach maternity services to rural and remote locations.
Women in rural and remote Australia have increased access to outreach maternity services.
1.3.2 AHMAC endorses a National Strategic Framework for Rural and Remote Health, which includes objectives and strategies to address access to health services in rural Australia.AHMAC evaluates the introduction of strategies under the National Strategic Framework for Rural and Remote Health to assess its impact on improved access to rural maternity services.AHMAC considers implementation of further strategies to support the sustainability of rural maternity services.Access to maternity services for women in rural areas is improved.

AHMAC = Australian Health Ministers' Advisory Council
MSOAP = Medical Specialist Outreach Assistance Program

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Action 1.4 - Increase access for Australian women and their family members to information that supports their needs for maternity care

(Aligned with Principles 1, 3, 8, 9)

Women and their families who live in remote and very remote Australian communities experience extremely limited access to locally available high-quality and culturally competent maternity care.

Community-based primary maternity care that is linked to secondary and tertiary services can provide quality maternity care in these communities, facilitated by technology to provide on-site specialist consultation and referral. This can reduce the need for women to travel away from their families, homes and communities for extended periods of time, and enables family members to be involved in their care.

The provision of primary maternity care requires an appropriately trained and qualified workforce supported by robust quality and safety systems that enable consultation, referral and escalation when necessary.

Maternity service planning and delivery for remote communities, including planning for workforce and infrastructure needs, will be informed by the development of tools to inform future planning (see Action 4.2.1), which will include the introduction of the National Strategic Framework for Rural and Remote Health (in 2010–11).

Many pregnant Aboriginal and Torres Strait Islander women are from remote Australian communities. As stated earlier, the outcomes for these women and their babies are substantially poorer than those for non-Indigenous mothers and babies. These inequalities need to be addressed (see Action 2.2).

Further related actions can be found in Actions 1.3, 2.2, and 3.2. Top of page

The initial yearThe middle yearsThe later yearsSigns of success
1.4.1 AHMAC identifies the characteristics of successful community-based maternity care in remote locations.Australian governments implement community-based maternity care in remote locations, based on successful models.Australian governments continue to implement community-based maternity care in remote locations.
Australian governments evaluate community-based maternity care in remote locations.
An increased number of remote communities have access to community-based maternity care.
1.4.2 AHMAC endorses a National Strategic Framework for Rural and Remote Health, which includes objectives and strategies to address access to health services in remote Australia.AHMAC evaluates the introduction of strategies under the National Strategic Framework for Rural and Remote Health to assess its impact on improved access to remote maternity services.AHMAC considers implementation of further strategies to support the sustainability of remote maternity services.Access to maternity services for women in remote areas is improved.

AHMAC = Australian Health Ministers’ Advisory Council

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