Australian doctors have attacked the federal government plans to give midwives the same responsibilities as doctors in natal care.
Health Minister Nicola Roxon has released a discussion paper on maternity services in Australia that calls for midwives to be given the same prescribing rights and access to Medicare rebates as doctors in antenatal and postnatal care. Consequent on the changes midwives will get a greater role in hospitals.
Australia's 12,000 midwives now have limited ability to access Medicare and can only do so when their treatment is overseen by doctors.
The discussion paper was part of a comprehensive review of maternity services led by the Chief Nurse and Midwifery Officer, Rosemary Bryant.
The review covered issues including support for a greater role for midwives; opportunities for women to have more birth-care options, including home births; the shortage of maternity staff and services, particularly in rural and remote areas; and rising levels of post-natal depression.
The paper says that as there is no Medicare benefit payable to midwives for management of labour and delivery, there is only limited support for midwifery services through private health insurance.
In most cases, mothers choosing to have their babies outside hospital pay the full cost of midwife services, which is typically more than $1000.
A key issue was expanding the scope within both the public and private sectors for women "to achieve greater choice and increased continuity of care.
Australian Medical Association (AMA) president Rosanna Capolingua said while she supported the use of midwives there was a greater chance of a baby dying during birth if born at home. "I think we have to very careful about this. We have been using midwives, we want to continue using midwives and we have to understand all the choices that are involved for them in midwife care," Dr Capolingua said.
"If they choose to have a home birth with a midwife they need to know there is three times greater risk of their baby dying, so we need to fully inform them," she said.
Pointing to Australia's low levels of infant mortality, she said of reducing doctors' supervision, "you're talking about putting at risk a mother and or a baby".
Dr Capolingua denied that doctors were merely looking to protect current dominance of maternity care subsidies. The average cost of a doctor's treatment for a pregnancy increased between 2006 and 2007 from $1088 to $1264.
"Midwives are very involved in obstetric care right now in a team environment under medical supervision and that model works very well. It's not about Medicare, it's about the medical supervision and the safety for the patient," she said.
The College of Obstetricians and Gynaecologists said it welcomed the review but any reforms to the delivery of maternity services had to be carefully evaluated.
They also say the Government should first consider what they claim are the ''harmful effects'' experienced in New Zealand, which moved to a midwife-led system in 1990.
Rural New South Wales obstetrician Pieter Mourik says one of the arguments in support of the midwife-focused model of care is that it would lead to fewer interventions, such as babies being born with the aid of forceps or by caesarean section.
''The experiment of midwife-led care in New Zealand has been a dismal failure, with double the maternal deaths and a similar increase in baby deaths and injuries.''
Mourik who now works as a relief obstetric locum in regional Australia to give respite to overworked rural doctors ó says a New Zealand coroner had recently ''pleaded'' for the country's GPs to resume providing maternity care, but Mourik says it is ''too late after a generation of exclusion''.
Mourik went on to assert that midwives had also ''become so stressed, working without immediate medical support, that they are dropping out of maternity care altogether and many have come to Australia to work, including to our local hospital.
Mourik says the push for a bigger role for midwives is based on ideology rather than evidence. ''This is the group pushing for home births, and we all know home births are more dangerous for the mother and the baby,'' he said.
Hannah Dahlen, of the Australian College of Midwives, says the comments represent the latest salvo in a ''scaremongering campaign'' by obstetricians determined to stymie efforts to give women greater choice.
Professor Cindy Farquhar, head of the New Zealand Government's Perinatal and Maternal Mortality Review Committee, said it was ''impossible to compare earlier maternal mortality rates with the current rates because of the completely different way that the data is collected''.
''To suggest that any increase has occurred because of the introduction to midwifery care is unjustified,'' Farquhar wrote in a letter to The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Dahlen says obstetricians are incorrectly claiming or implying that midwives are seeking to be in sole charge of births.
''We are not asking for midwives to be out there on their own we don't want that,'' Dahlen said.
''What we want, what we have always wanted, is collaborative models of care, where women can have a midwife who cares for her through her pregnancy and postnatal period.