Using your politicians to change birth services

By Bruce Teakle

This article was written as a campaign tool for those working to obtain better maternity services in Australia.  The National Maternity Action Plan was launched in 2002. For full details find out more here.

This article is for people wanting better access to better birth care. It is intended to be a guide to advocating to your political and bureaucratic servants what you want. It has been distributed to support the National Maternity Action Plan (NMAP) campaign in Australia.

Why?

If we want to improve this situation and get access to the sort of birth care we want, we are going to have to go out of our own comfort zones and do the things necessary to make political change. A big part of this is to communicate with the politicians and bureaucrats who should be serving us better. The purpose of this guide is to help you do that.

The success of the current campaign being organised around Australia depends on the active involvement of the grass roots of the birthing community. To succeed in achieving reform will require every supporter to make themselves heard. Politicians need to know that there is a problem before they will support the NMAP as a solution.

We have to ask for what we want

What do we want?

I can’t tell you what you want, but the common messages are that women want:

• Informed Choice – mother as principal decision maker, place of birth, intended intervention strategies, people present at birth, etc., decided by mother with carers in educational role.
• Holistic care – taking a broad range of relevant factors into care such as family relationships, emotional issues, nutrition etc.
• Continuity of care – developing a close trust relationship with a main carer who attends through antenatal, birth, possible medical intervention, maternal stages.
• Low intervention – mothers tend to prefer not to receive unnecessary interventions, carers tend not to advise interventions unless necessary and backed by evidence.

These elements are commonly held to be part of the Midwifery model of care, as opposed to the Medical or Obstetric models of care, which emphasise having doctors in charge of a team of carers, whose focus is on preparing for possible complications.

Midwifery care by a woman’s choice of midwife, in a woman’s choice of place of birth, is freely available from the public health systems in Britain, Netherlands, New Zealand and many other countries. Publicly funded home birth schemes are operating in Western Australia, ACT and South Australia. What we want is available to many women in other places.

The short way of saying this is that we want midwifery models of care in homes, birth centres and in hospital.

What have we got?

Women in Queensland currently have nearly no choices in birth care.

The hospital services available do not respect women as being able to make decisions for themselves about birthing, and have unacceptable rates of intervention and consequent injury. The most recent statistics available for Queensland are for the calendar year 1999, that is 2 1/2 years ago. In that year 24% of Queensland births were by caesarean, another 9% were by forceps or vacuum. That means 1/3 of babies were delivered surgically, not including the large proportion of mothers and babies who were given artificial hormones (to start or speed up labour), anaesthetics, or episiotomies. Given persistent stories from hospital workers that intervention rates are rising steeply, who knows what the numbers are now.

Queensland consumers are being treated like mushrooms by Queensland Health. The only figures on birth interventions available to consumers (the people at the sharp end of the knife) are well out of date, and only give averages for the state. Figures on individual hospitals – very important for informed choice making – are only available for public hospitals on payment of a $120 fee, and private hospital statistics are totally secret. Queensland Health is unable to identify any process by which these figures are reviewed in order that problems may be responded to. Unaccountable and out of control.

Birth centre care is not available by choice, due to the tiny number of places available in Queensland’s 2 state run birth centres. Groups all over the state have been asking for birth centres in local hospitals, but have been left frustrated.

What makes birth centres different is that they (usually) offer a “midwifery model of care”. This is care in which midwives are the lead carers, and medical assistance (from doctors or obstetricians) is only used if a complication arises which is outside the competence of a midwife to deal with. Most desirable is if the woman has one or two midwives giving her “continuity of care” through the whole pregnancy, birth, and postnatal process. Hospitals all give care to birthing women from midwives, but the midwives are generally subservient to doctors, change with the shifts, and rarely have met the woman before the birth. In hospitals midwives have to conform to the medical model determined by doctors.

Conditions for independent midwives have become so unacceptable that homebirth care is all but unavailable. Midwives have no access to indemnity insurance, are treated hostilely in hospital transfers, and complaints against them result in the Queensland Nursing Council’s harsh investigation process.

So far, attempts to discuss these problems with the state government have fallen flat. They are comfortable with their intervention focused policy, and prefer not to change.

Our job is to make change happen.

Who is responsible?

There are a lot of people responsible for the current situation, including us. Probably no-one wants women to have a bad disempowering experience. The main attitudes we have to deal with are:

• “Birth care problems? Never heard of them. There must be no problem.” This would apply to most politicians. They mostly have never heard of us or our birth care problems, and have been busy responding to other people who bring other problems in to them. When we met with two key people at the very centre of Queensland health we were told “we never hear bad stories about hospital birth, only good ones”.
• “We have to protect mothers and babies (including from themselves)” The health bureaucrats include many doctors, who genuinely believe that birth interventions happen only to save lives, and that women should be prevented from making choices (wrongly assumed to be) harmful to themselves or their babies i.e. home birth.
• “Visit my member of parliament? I’m just a mother, and he wouldn’t be interested.” We have been invisible because we have made ourselves invisible.

To get service, we have to tell our servants what we want. All of the “powerful” people who are responsible for arranging the system are our employees, who are paid by our taxes, and whose work is determined by the outcome of elections we vote in. It’s easier for them if things stay the same, but they will respond to the public if they have to.

The Politicians

Except at elections, the peak decision makers are politicians.

Each of us have 2 members of parliament, one federal and one state. These members know that they are directly elected by us, and that they may be elected or not by a margin of only a few votes. They want to be your best mate, so you will tell your friends and you’ll all vote for them.

Your members of parliament are responsible for representing you in the government. If you have a problem, you tell them, and they should try to resolve it. In return, they want to be seen to have been helpful, so voters in their area (their constituents) are more likely to vote for them.

Your state member is the one who is most important in the birth reform game. Most of the delivery of health services is by your state government. Your federal member is also important. Issues like funding, and obtaining indemnity insurance for midwives need federal government support. It’s good to tell both of them what your concerns are.

Finding who your MP is

To find out who your members of parliament are, you can phone the Australian Electoral Commission (AEC), whose number is in the phone book. In South East Queensland the phone number is 3227 6444.

When you phone the AEC, give them your address, and ask:

• what is your state electorate,
• who is your state member of parliament,
• what is their phone number,
• what is their address, email or post,
• the same questions about your federal member, if you’re planning to do them too.

Don’t worry if you’re a Kiwi, or otherwise not enrolled to vote. They won’t ask.

Write them a letter

The first and easiest way to make yourself heard politically is to write a letter. It is useful to tell them what you want, and is also an act of creative self expression and power which has a positive effect on yourself. It’s good to write to both your state and federal MPs. If you are short of time and energy, start with the state MP.

Tell them:

• Who you are – To start with, you are their constituent. The identities of woman, mother, pregnant woman are very important socially and politically. So if that’s who you are, tell them. Don’t forget who politicians like to be photographed with during election campaigns – mothers and babies.
• What you want – What do you want? Choice? Respectful service from the public health system? Access to a birth centre at your own choice, rather than if your name is drawn out of a hat, or if a hospital administrator lets you? To birth at home in your own nest with your own choice of carer?
• Why you want it – They probably don’t understand why you want these things. They deserve an explanation. Perhaps you consider hospital care too risky, too disempowering, or just wouldn’t consider it unless you were dying. You may have had some direct experience, or have read about, and want to avoid, the high rates of intervention in hospital care. You may prefer to choose a single favourite midwife to be with you for care before, during and after birth, instead of various strangers who change with hospital shifts. You may like to refer to statistics or books or personal preferences.
• What you want them to do – Your MP is your representative of your government. You tell them what you want your government to do, and you can ask them to do something for you themselves.
• You might ask them to:
  • Support women’s access to her own choice of midwife for care before, during and after birth.
  • Support policy changes to make birth centres available to all Queensland women.
  • Support the NMAP.
• You might ask them to answer a question or two:
  • Are they concerned about the current rates of intervention in birth?
  • Have they heard about the Community Midwifery Programs in Perth and Canberra?
  • What is the government doing to solve the lack of insurance for midwives?
  • Who is responsible for maternity care policy in this state?
  • What processes are available for consumer input into maternity care policy?
  • Who is responsible for overseeing private hospital birth outcomes?

It’s your letter

Remember, you don’t have to be a professor of obstetrics to write to your MP. Don’t write what you don’t feel or you don’t know. It’s a good opportunity to have your own knowledge challenged, and clarify your ideas or do some research, but your MP is more interested in your opinion than how clever you are (just look at government policies).

Anger

Anger can get us motivated to start our political involvement, but it can sap our power. Showing anger can put you in a powerless position by drawing attention to your emotions rather than the substance of what you are saying. Remember you probably wouldn’t change places with your MP for anything, and they are a person like you. Write with the assumption that you will be listened to respectfully, and it will be more likely.

The next step

Writing your first letter to your MP is only a first step. You can email or post your letter. Either way, it’s a good idea to phone up and ask if they’ve received it after an appropriate time.

If you can do it, it’s good to arrange a visit to them at the same time. Meeting and talking with your MP is very useful to you. It is interesting and empowering for you to meet them, and it helps them to make the issue real, and make your determination more obvious.

Meeting your MP

You can easily get an appointment to meet your MP, it’s their job to be accessible to you. Just phone their office, and tell their secretary that you would like to arrange to meet your MP. They will want to know what you plan to talk about, and will find a time in the MP’s diary. If you plan to take a friend or someone from a support group, tell them who is coming. It’s good to take support, mostly for your own confidence, but it also shows bigger numbers and gives two or more heads to see what’s going on and answer questions.

Meeting your MP requires the same preparation as writing a letter, and sending a letter first is very helpful. The letter explains what you want, and the meeting makes sure they read the letter and understand your concern. Going along and showing yourself as a real person will be a much stronger memory to your MP than just another letter.

Your MP wants you to love them. Don’t expect to be given a hard time and have to know every detail about birth physiology and the state health system. Hopefully they will be interested enough to ask questions, but it won’t be an exam for a medical degree. Get some facts ready for obvious questions, but be prepared to get back to them with the answers you don’t have.

Dress straight. Like you’re going to church, not the hellfire club or Aquarius festival. Don’t mention vaccination, home schooling or conspiracies by drug companies. Don’t be too hard on doctors and obstetricians – it helps to recognise that they are a useful tool sometimes. In a minority of births medicine can save lives, but in most births it just makes it harder for women and babies. Be straight – don’t distract them from the issue you have gone to speak about. Deal with one diversity at a time. It makes it easy for them if they can dismiss you as a whacko. The birth issue has all the evidence on our side, the only thing against us is that the people it matters most to are busy raising the next generation.

The biggest issue for many people, including MPs is fear. Many people believe that birth is a life and death struggle which should only happen in an operating theatre under the control of a team of medical specialists with a truckload of machines. Luckily for us there is no evidence to support this myth, and a wealth of scientific evidence against it. The best available evidence shows that for a healthy woman with access to hospital backup, birthing at home is as safe as in hospital. If anyone challenges this, ask for evidence. If you are asked for evidence (a good thing to be asked) then do some homework and provide them with some. Ask for help from someone in the birth groups if you like.
Going through the system

Health care is the responsibility of the Minister of Health. Your MP is likely to read and acknowledge your letter, and pass your letter on to the Minister. You should eventually get a reply from the Minister. The Queensland Minister for Health is currently Wendy Edmond, who is strongly committed to obstetric hospital birth care. She won’t be there forever, and part of our task is to get prepared for a better Health Minister.

The Fob Off

Our experience so far is that the reply you receive will be a complete fob off. This will be written by an officer of the department, who probably doesn’t know much about the issue, but can cut and paste paragraphs from previous letters replying to other citizens. It will probably use plenty of long words and refer to various policies and reports you are expected to be unfamiliar with, and is intended to take the steam out of you. They don’t expect you to reply, and if you don’t, then they will think that you are satisfied with their reply and the matter is over.

Persist!

Be kind, and realise that this is just them doing their job. If they changed policy every time they had a letter about something, government would grind to a standstill. So, be ready to respond to the fob-off. For this, it’s good to get some help if you aren’t sure of the facts. Show your letter from the minister to people who are familiar with what it’s talking about, and find out what the letter means. Then reply to the minister and tell them you aren’t happy with their response.

Tell your MP you weren’t happy too. Send them a copy of your letter to the Minister. Tell your MP about what’s happening every time you can. Keep the issue alive and on their mind.

Remember, these people all get a hundred letters and emails a day. Yours can easily get lost if you forget it. If you don’t get replies, phone up and ask about it. Persist!

You are the citizen and customer. They are accountable to you.

Other points

The National Maternity Action Plan

Even though it hasn’t been launched yet, the NMAP is a very useful tool. It shows that birth groups are organised and serious about achieving change, and it is an excellent overview of the situation, the evidence, and a proposed reform process. Send anyone you are lobbying a copy if you desire. Ask them later what they thought of it (get them to actually read it).

For a copy of the NMAP or more information about the NMAP campaign, go to: http://www.communitymidwifery.iinet.net.au/nmapcampaign/nmapindex.html

It generally works better to send the PDF of the NMAP as an email attachment to someone you are lobbying rather than just telling people to get it for themselves.

The “it’s not my responsibility” game

MPs (especially federal) like to say that our problems are the responsibility of the other level of government. Federal MPs have been saying that health is delivered by State governments so birth care is not a federal problem. They’re wrong.

The federal government is responsible for these things:

• Funding health care. They fund doctors but not midwives through medicare. They can make funds available for alternative health services such as community midwifery programs.
• The legal framework of laws which make insurance unavailable to midwives. The federal government has a responsibility to coordinate the legal changes necessary to make it possible for midwives to get insurance again. They are putting big money and effort into solving it for the doctors and should be doing the same for midwives.
• The policies around Australia’s choices in health systems. The health systems they fund and support with research and policy pour hundreds of millions of dollars into funding the avoidable injury and trauma suffered by tens of thousands of Australian women every year. It costs them more than 100 million dollars a year extra just to pay for all those caesarean births that would be normal births in the Netherlands (We have 22% Caesarean Section, Netherlands has 9%).
• They fund the education system which doesn’t produce independent midwives.

The state government is responsible for nearly everything else:

• They run the hospitals.
• They ask for funding for their choice of health care system.
• They own the Nursing regulators which control midwives and persecute homebirth midwives.
• They are responsible for setting up (or not) birth centres.

Support from the Action Group

Please ask us if you want some help with writing, replying or visiting. It can be very effective to have a campaigner plus mothers team.

Please let us know what happens with your letters and visits.

Summary

• Reform of birth care is achievable if we all make ourselves heard and persist.
• Write and visit your state Member of Parliament, and your federal MP too.
• Tell them what you want them to do. Give and expect respect.
• Don’t be disempowered by fob-offs.
• Get support from your networks
• you are not alone, and we have a powerful network to support us with science, politics and love.

This article was written as a campaign tool for those working to obtain better maternity services in Australia.  The National Maternity Action Plan was launched in 2002.