Speaker 1: From The Australian. Here's what's on the front. I'm Kristin Amiot.
Speaker 1: It's Tuesday, April fifteenth, twenty twenty five. A man who
Speaker 1: led pro Palestine protests on the University of Sydney campus
Speaker 1: will appear on the Greens Senate ticket in the upcoming election.
Speaker 1: Ethan Floyd is one of a handful of Green's candidates
Speaker 1: who came to prominence following the October seven attack on
Speaker 1: Israel by Hamas militants. The major parties are going tit
Speaker 1: for tat on cost of living relief in the run
Speaker 1: up to the federal election on May three, and it
Speaker 1: could come at the expense of our defense force. The
Speaker 1: pre poll cash splash is threatening to push a boost
Speaker 1: on defense spending into the next decade. Those exclusive stories
Speaker 1: alive right now at The Australian dot com dot au.
Speaker 1: Obstetricians offering to help women give birth in the private
Speaker 1: healthcare system are leaving the field altogether because public hospitals
Speaker 1: won't let them deliver babies at their facilities. It's part
Speaker 1: of a bigger problem plaguing birth in Australia, and experts
Speaker 1: say it's only going to get worse if big structural
Speaker 1: changes aren't made. That's today's episode. In twenty fourteen, Bendigo
Speaker 1: woman Karin Cintel made a mad rush to the hospital.
Speaker 1: Her baby girl, Matilda was coming and she wasn't gonna
Speaker 1: wait for Karin to arrive at Castlemaine Hospital. About forty
Speaker 1: minutes down the road, Karin's husband Mishi, pulled over near
Speaker 1: a fruit shop on the Midland Highway and she delivered
Speaker 1: Matilda right there in the passenger seat. It just so happened.
Speaker 1: The family's birth photographer, Brianna Gravener, was also on the road.
Speaker 1: Karin's birth photographer, Brianna had followed the couple from their
Speaker 1: house and captured the entire experience on camera. They suddenly
Speaker 1: pulled over and I thought, this is it. It was
Speaker 1: the first click and that was Matilda coming out. Amazing
Speaker 1: and unbelievable. Birth stories like this one are told around
Speaker 1: Australia and the world, but not all Australian babies are
Speaker 1: in as much of a rush as little Matilda. They're
Speaker 1: born in hospitals carefully selected by their mums and dads.
Speaker 1: In Australia, they have the choice between private hospitals which
Speaker 1: are funded by health insurance premiums and the public system,
Speaker 1: which is paid for by taxpayers. The private healthcare system
Speaker 1: was introduced to take the pressure off the publicly funded system,
Speaker 1: but when it comes to the business of delivering babies,
Speaker 1: the private system is in big trouble.
Speaker 2: There's been eighteen birth units that have closed in private
Speaker 2: hospitals in Australia over the past seven or so years.
Speaker 1: Natasha Robinson is the Australian's Health Editor.
Speaker 2: But this trend is accelerating, so about ten of them
Speaker 2: have been in the last three to four years, and
Speaker 2: the prospects, or the modeling of the prospects, are quite dire. Indeed,
Speaker 2: there has been modeling published recently in the Medical Journal
Speaker 2: of Australia that predicts a very precipitous decline of private
Speaker 2: births that will cause greater shutdowns of these units, to
Speaker 2: the extent where private birthing may be extinct. It is
Speaker 2: described in Australia by twenty thirty.
Speaker 1: So why are private birth units closing?
Speaker 2: Well, Australia has a declining birth rate. It's actually at
Speaker 2: an all time low. Our fertility rate is falling year
Speaker 2: upon year and it's affecting both systems. But the decline
Speaker 2: of the births in the private systems have more complex
Speaker 2: reasons them and they include factors to do with private
Speaker 2: health insurance, out of pocket costs to families, incredibly high
Speaker 2: costs to private hospitals to staff these units, and it
Speaker 2: really is becoming unviable for many hospitals. And the fact
Speaker 2: is that at the moment they are only really keeping
Speaker 2: them open because that is the service to the community.
Speaker 2: Many of these private birthing units are causing such a
Speaker 2: drain on the hospitals that they're being operated at a loss.
Speaker 1: The problem is when expectant mums can't access the private system,
Speaker 1: they turn to public hospitals and services to have their babies,
Speaker 1: and that could cost us all dearly in the long run.
Speaker 2: There's been some recent modeling done by a Monash University
Speaker 2: professor by the name of Emily Calendar, who is an
Speaker 2: economist and she specializes in women's and children's health. She's
Speaker 2: analyzed birthing trends in Australia and really use quite conservative figures. So,
Speaker 2: for instance, if we had a few two percent decline
Speaker 2: in bursts in the private system in Australia, which is
Speaker 2: really not out of the question in terms of where
Speaker 2: these numbers are going, then taxpayers would effectively subsidize the
Speaker 2: public system where women would have to go to give
Speaker 2: birth to the tune of a billion dollars annually. And
Speaker 2: she said if the entire system collapses, it'd be a
Speaker 2: one point five billion dollar cost to taxpayers because women
Speaker 2: would have no other choice. That is also amplified by
Speaker 2: the fact that her analysis shows that if you compare
Speaker 2: like for like women and labors and births, adjusted for
Speaker 2: all those factors like socioeconomic status, high risk pregnancies, and
Speaker 2: clinical factors to do with the health of the mother,
Speaker 2: then actually still cost tax payers more to subsidize a
Speaker 2: birth in a public hospital than it does in a
Speaker 2: private hospital. And that's for all sorts of reasons of efficiency,
Speaker 2: continuity of care obstrations, having to account for every cost
Speaker 2: whereas as hospitals don't, so the costs are really enormous.
Speaker 2: Here to put it in perspective, it's a fair chunk
Speaker 2: of the entire extra budget that the Commonwealth and states
Speaker 2: have tipped in two hospitals in the National Health Reform
Speaker 2: Agreement that has been signed recently, which is just an
Speaker 2: interim agreement. So it's a very large figure and more importantly,
Speaker 2: it's a tragedy if people were not to have a choice,
Speaker 2: because our health system is predicated on universality and choice.
Speaker 1: So how do you stop the bleed?
Speaker 2: Look, we have seen some plans devised recently, and this
Speaker 2: is supercharged by this sleeper issue that there is this
Speaker 2: emerging evidence also done by Emily Calendar and her colleague,
Speaker 2: professor Elaina tid At Monash, which shows a higher rate
Speaker 2: of adverse outcomes in the public system versus the private system.
Speaker 2: So the solutions that are on the table at the
Speaker 2: moment are things like devising national law so that each
Speaker 2: state adopted the same laws that would guarantee things like access,
Speaker 2: they would transparently track outcomes, and there's a number of
Speaker 2: aspects of things that could be regulated and legislated in
Speaker 2: a law like that, and that is modeled on many
Speaker 2: national laws that govern issues in all sorts of milias
Speaker 2: of society. Another one is some adjustments to private health insurance.
Speaker 2: So at the moment, people who have gold Cover are
Speaker 2: the only ones virtually that have that access through their
Speaker 2: private insurance to services for maternity, and a lot of
Speaker 2: the time people don't realize that they downgrade they cover
Speaker 2: that don't realize they're not covered for maternity. Another one
Speaker 2: is just to actually force all public hospitals to open
Speaker 2: up their systems so that private obstetricians can deliver babies
Speaker 2: in public hospitals. From their point of view, that's not
Speaker 2: ideal because it is actually not the same mode of care.
Speaker 2: They can't plan their cesarean sections easily, for instance, because
Speaker 2: they don't know if they're going to have access to theaters,
Speaker 2: et cetera, et cetera. So that is not ideal. But
Speaker 2: that's one of the solutions being proffered.
Speaker 1: Coming up, while some obstetricians are getting out of the
Speaker 1: game altogether.
Speaker 3: Having a baby can be a time of immense vulnerability
Speaker 3: and fear for many women.
Speaker 1: This is doctor Anusha Lasari, a specialist obstrarician and gynecologist
Speaker 1: based in Far North, Queensland, and knowing.
Speaker 3: That a single clinician is in charge of her kid
Speaker 3: and is fully accountable for her experience as well as
Speaker 3: her outcomes, allows women to bork without fear and with
Speaker 3: confidence because she knows this clinician will stand with her
Speaker 3: come what may.
Speaker 1: Doctor Lasari has spent a good chunk of her career
Speaker 1: in Australia, providing medical care to women living in remote
Speaker 1: and regional communities up north.
Speaker 3: Continuity of care also makes the patient journey safer. One
Speaker 3: set of eyes on one patient, not just in their
Speaker 3: first pregnancy, but every subsequent pregnancy allows that clinician to
Speaker 3: recognize evolving risks early and perform timely small intervention measures
Speaker 3: that prevent major address outcomets.
Speaker 1: But as private birth units are shuttered around the country,
Speaker 1: this type of continuous care is becoming a rarity. Adding
Speaker 1: to the problem is the fact that some obstratacians are
Speaker 1: leaving the field. Here's Natasha Robinson.
Speaker 2: You do have a situation in cans where the entire
Speaker 2: a cohort of private obsetricians, and that a couple of
Speaker 2: years ago there were seven of them are now not
Speaker 2: working in obstetrics and not delivering babies at all. A
Speaker 2: couple of them have left town. The ones that are
Speaker 2: left mostly doing only gynecological services. And I don't think
Speaker 2: it's putting it dramatically to say that they're grief stricken.
Speaker 2: They are devastated, and patients are also devastated because they
Speaker 2: have to travel to give birth with a private obstetrician.
Speaker 2: We have an entire capital city of Darwin, where the
Speaker 2: private birthing unit at the Healthscope Hospital is about to
Speaker 2: shut down in three days and women there across the
Speaker 2: hole of the top end have no option but to
Speaker 2: birth in the public hospital. Now it's better there because
Speaker 2: they do still have their private obstrition. Their private obstricans
Speaker 2: have been granted access to birth in the public system
Speaker 2: in terms of cans. That did happen initially, but that
Speaker 2: right has been removed by the local hospital disc and
Speaker 2: it's unclear as to why that has happened. The solution
Speaker 2: that makes the most sense to me in my discussions
Speaker 2: with doctors is that the Medicare funding for the actual
Speaker 2: delivery of the baby, if it's done in the public hospital,
Speaker 2: flows to the hospital if that birth is done a
Speaker 2: public obstrician, But if it's a private obstrician coming in
Speaker 2: delivering that baby, that Medicare rebate goes via the patient
Speaker 2: to the obstrician themselves. So I don't know what the
Speaker 2: reason is, but it's certainly surprising, and it's something that
Speaker 2: a great deal of pressure is now building for a
Speaker 2: change that which we really could be done at the
Speaker 2: stroke of a pen.
Speaker 1: So what does this all mean for mums and bubs.
Speaker 2: What it means is that they don't have a choice.
Speaker 2: In some places in Australia, this is an escalating situation
Speaker 2: and it's not to mention even the rural areas where
Speaker 2: this has been happening for years and women are traveling
Speaker 2: enormous distances, they're relying on private midwives. It really is
Speaker 2: quite extraordinary. And the situation for women is they're facing
Speaker 2: perhaps a different standard of care because the most important
Speaker 2: thing that everybody agrees upon in antinatal care and labor
Speaker 2: and delivery is that there is continuity of care. I
Speaker 2: think that is the message that non continuity of care
Speaker 2: models involving multi professionals in public systems where there's this
Speaker 2: sort of divide between oftentimes midwives and obstetricians, is not working.
Speaker 2: And there is an alternative, excellent model in the public
Speaker 2: system which is midwiffree group care, and that has very
Speaker 2: good outcomes. If we cannot solve these big problems in
Speaker 2: terms of the viability of private hospitals and the birthing units,
Speaker 2: in terms of the fertility trends that really are such
Speaker 2: a huge problem to solve, the problem we can solve
Speaker 2: is actually adjusting our models so that they can be
Speaker 2: of the highest standard of best practice. And I really
Speaker 2: think that's probably the gold mine here where you're going
Speaker 2: to find a lot of progress. And the critical other
Speaker 2: point to keep in mind is that our progress on
Speaker 2: these matters must be transparent. So that is the big push.
Speaker 2: It has to be that women are told that they
Speaker 2: can look up information that is not just all about
Speaker 2: the mode of delivery, that is not just all about
Speaker 2: was there an intervention or not, but is about the outcome.
Speaker 2: They are the figures that we need. They're the figures
Speaker 2: that we currently don't have. They're not available at all.
Speaker 2: It's incredibly difficult for researchers to get access to them,
Speaker 2: let alone birthing women. So that's an incredibly important reform
Speaker 2: as well that we need to move towards.
Speaker 1: Natasha Robinson is The Australian's Health Editor. You can read
Speaker 1: all her reporting and analysis of the crisis engulfing the
Speaker 1: nation's maternity wards anytime at the Australian dot com dot
Speaker 1: au