Tas doctors "strongly oppose" any taxpayer-funded home birth scheme

On Friday, the Tasmanian Department of Health invited feedback on a consultation paper “to inform the development of a new Tasmanian Public Homebirth Program, which will draw on the evidence base, best practices and the experiences of other Australian jurisdictions where public homebirth models have been implemented”.

In its invitation for feedback, the Tasmanian Department of Health said, “Public homebirth is a safe and woman-centred model that leads to positive outcomes for women and babies, and increases the scope of practice for midwives.

“The Department is committed to listening and responding to Tasmanians, and the release of this consultation paper today is an important step towards the development of a public homebirth model in Tasmania.”

The introduction a public homebirth model in Tasmania would, the Tasmanian Department of Health said, “provide access to an alternative model of safe and woman-centred care that is personalised to the woman, [and] is respectful and empowering”. It was also said that this model of care would “be beneficial for our highly valued midwives across Tasmania, by creating professional opportunities for them to work to their full scope of practice”.

AMA Tasmania’s stance on a government-provided homebirth program

Also on Friday, the Australian Medical Association Tasmania (AMA Tasmania) said AMA Tasmania doctors “strongly oppose any taxpayer-funded homebirth scheme, which we know increases risk to mother and child”, instead supporting midwifery care and other continuity of carer models (including GPs) within a collaborative team environment within a hospital setting and calling on the state government “to put on hold any plans for a government-provided homebirth program”.

Arguing that the safest place to give birth is a hospital — where obstetricians, anaesthetists, paediatricians and surgical facilities are immediately available if needed — among AMA Tasmania’s key concerns were:

• Rapid escalation is critical — where immediate, multidisciplinary care is required in events such as severe bleeding, cord prolapse, fetal heart rate abnormalities and neonatal breathing difficulties, with hospitals providing onsite obstetrics, anaesthesia, operating theatres, blood banks and paediatrics.
• Higher vulnerability for first births — with risks greatest for first-time mothers and when transfer is required during labour, AMA Tasmania said a government-endorsed homebirth model may unintentionally normalise higher-risk settings.
• System pressure and equity — where publicly funding homebirth diverts scarce resources from strengthening hospital maternity services, which are safer.
• Medico-legal and duty of care — where the standard of emergency response can never match an acute hospital, a state-run program endorses a setting that, AMA Tasmania said, “exposes families and clinicians to avoidable risk and the health system to liability”.
   

“Our duty is to back the safest system for mothers and babies,” AMA Tasmania said. “We absolutely support woman-centred care, choice, and culturally safe services. But ‘choice’ must sit within a system designed first for safety. The public health system shouldn’t underwrite a setting where we know the risk to mother and child is higher, and the ultimate cost to the system is greater if it all goes wrong.

“The fact that no commercial insurer was prepared to ensure private-sector midwives for homebirth settings, and the Commonwealth legislated to expand the government-backed Midwife Professional Indemnity Scheme (MPIS) to include out-of-hospital intrapartum care (homebirths), speaks volumes.

“There is also a greater risk of the state government being sued when this goes wrong, increasing the financial cost to the government.

“Government funding homebirths sends the wrong message, when we know the safest place to deliver a baby is within a hospital.

“Rather than the state supporting the homebirth rate, currently at only 0.3–0.6% of all births across Australia, the Minister needs to ensure that our women’s and children’s facilities are upgraded across the state, so we can support safer birthing and collaborative care in hospitals built to meet demand.”

The consultation paper is available here, via the Tasmanian Department of Health website.

The Tasmanian Department of Health invites feedback on the consultation paper here, via its website, with formal consultations to continue until 19 October.

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