I am pleased to provide you with the Report of the Maternity Services Review.

This Review has made it even clearer to me that pregnancy, birthing and early parenthood are profoundly important life experiences. As well as the physical, social, practical and emotional dimensions of these experiences, the time leading up to birth, the birth itself and the postnatal period are for many women and their families infused with deep spiritual and/or cultural significance.

For the many individual women who contributed to the Review, their motivation to engage was often based on dissatisfaction with the current system and the choices that were or were not available to them.

While views expressed by those who contributed to the Review were often divergent, there was widespread agreement about the issues that present the greatest policy challenges, as well as consensus that safe, high-quality and accessible care based on informed choice must be the goal to which we aspire.

Addressing this goal has provided the focus and backdrop for this Report and its recommendations. While defining the goal is relatively straightforward, a more challenging task lies in deciding how this goal is best achieved for women and their families, including women in rural and remote areas, Indigenous women and women with ‘high risk’ pregnancies.

Of the many significant issues contained in the Report, there are three that I bring to your attention:

First, it is clear that there are many strengths in our current system, most notably by our strong record of safety and quality. This must not be understated: generally speaking, we have in Australia a highly committed and professional maternity services workforce that is looking after mothers and babies extremely well. However, in light of current evidence and consumer preference, there is a case to expand the range of models of maternity care.

Secondly, it is imperative that we do more to improve the birth outcomes for Indigenous Australians. For most organisations participating in the Review, disparities in outcomes for Indigenous mothers and babies are considered a most pressing national issue.

Thirdly, there is a lack of unanimity within and between some groups of the medical and midwifery professions on the issue of how to deal with risk and consumer preferences. While it is acknowledged that safety and quality of care is an overarching goal, it would be remiss to always use it as an excuse not to change practice. In maternity services, where most pregnancies follow a normal pattern, we must ensure, first, that practice is based on evidence and, second, that we are not allowing our safety and quality concerns to prevent us acting on evidence that supports changes to practice. Risk must always be a carefully monitored balance of safety and informed choice.

The divergence of views also involves the issue of what extra services taxpayers should fund to meet the desires or preferences of individuals and practitioners. Any final policy recommendation must reflect a considered analysis of the positions of all stakeholders. Nonetheless, the submission process highlighted many maternity services where medical practitioners and midwives work well together.

The issues raised by the Review are difficult and complex. There is a clear role for leadership by the Australian Government in concert with the state and territory governments to ensure that Australian women and their babies are provided with the best possible care. There is equally an onus on the professions to work with governments to achieve this.

I am conscious that the findings of this Review may not satisfy all contributors. Nonetheless, the case for change is unarguable.

In presenting this Report, I would like to acknowledge the hard work and dedication of the Review Team in the Department who have supported me in the conduct of the Review. I would also like to extend my thanks to those who contributed to the Review.

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Rosemary Bryant
Commonwealth Chief Nurse
and Midwifery Officer
February 2009