Rural and Remote Families - the Ones to Suffer

30 Jan 2010

That will allow doc­tors, who do not have to have obstet­ric train­ing, to claim Medicare when nurs­es, who do not have mid­wifery train­ing, pro­vide ante­na­tal care on their behalf. This would apply even though both may not be in the same town. 

These changes to Medicare Item 16400 will only occur in rur­al and remote areas and were intro­duced despite a con­sen­sus state­ment from eight nurs­ing and mid­wifery organ­i­sa­tions and the Aus­tralian and New Zealand Col­lege of Obste­tri­cians and Gynae­col­o­gists high­light­ing the risks.

It’s sim­ply out­ra­geous” states Asso­ciate Pro­fes­sor Sue Kildea, Vice Pres­i­dent of CRANAplus they wouldn’t do it in the cities — once again we are dilut­ing the pro­vi­sion of health care to Aus­tralians in remote areas, par­tic­u­lar­ly Abo­rig­i­nal and Tor­res Strait Islander Aus­tralians; a far greater pro­por­tion are liv­ing in these areas with more moth­ers and babies dying in childbirth”.

It’s sim­ply not appro­pri­ate to pro­vide an ante­na­tal train­ing pack­age for nurs­es in rur­al and remote areas and pre­sume that this is enough. Not only is it against inter­na­tion­al rec­om­men­da­tions, but it is in these areas that we should be pro­vid­ing increased mid­wifery resources not piece­meal solu­tions” Kildea states. It flies in the face of World Health Organ­i­sa­tion rec­om­men­da­tions regard­ing the pro­vi­sion of ante­na­tal care, the pro­tec­tion of the pub­lic and accred­i­ta­tion of cours­es. We have high­er rates of moth­ers and babies dying in the bush and instead of sit­ting down and look­ing at how we can increase the mid­wives work­ing in these areas, we have gone for this ill-con­ceived idea”.

Coun­tries around the globe are striv­ing to make preg­nan­cy safer to reduce the mater­nal and peri­na­tal mor­tal­i­ty rate by ensur­ing mid­wives are locat­ed in the fur­thest reach­es of the world. If this strat­e­gy real­ly was about increas­ing ante­na­tal care out in the bush, then mid­wives would be able to claim Medicare in their own right. This might encour­age them to stay in rur­al and remote areas, and would bring more fund­ing into these starved communities.

Remote area nurs­es do not want this respon­si­bil­i­ty; they want mid­wives work­ing side by side with Abo­rig­i­nal health work­ers to pro­vide ante­na­tal care. It is a safe­ty and qual­i­ty issue. To be hon­est, I am sur­prised that the insur­ers are allow­ing this to occur when mid­wives are unable to gain insur­ance to per­form the skills, and use the knowl­edge, that they have been trained in accred­it­ed pro­grams to do. Do the Aus­tralian pub­lic realise the impli­ca­tions of this? We can only assume they do not”.

Urgent action is required to ensure that skilled care is avail­able for all women in this devel­oped coun­try of ours, this must be seen as a non-nego­tiable nation­al priority.


Asso­ciate Pro­fes­sor Sue Kildea
Vice Pres­i­dent Coun­cil of Remote Areas Nurs­es of Aus­tralia
0418 289 199