Many women don’t feel safe to ask for help when they’ve had a baby, a parliamentary inquiry has heard.
The number of women seeking help from support services after giving birth is surging, with service providers telling a parliamentary inquiry that women are “filling a critical gap in a fragmented system”.
The Senate Select Committee on Women’s Health hearing in Adelaide today was told that the rising prevalence of psychosocial issues such as domestic and family violence, food insecurity, and alcohol and drug use were increasing levels of distress among new parents.
Stephanie Malan, midwife, co-founder and CEO of The Village Co – a South Australian registered charity supporting women through pregnancy and the first 12 months after birth – said many women did not feel safe asking for help.
Ms Malan said the women most in need of support were those in financial crisis, living with domestic and family violence, struggling with their own mental health, or without a safe place to call home.
“As a midwife, I watched these mothers discharge within hours of giving birth, without the basics for themselves or their baby.
“Again and again, I saw women walk off the ward, already believing they were failing before they’d even begun. Many have so little and no village around them.”
Ms Malan said The Village Co supported 3000 mothers and families in the previous financial year and expected to support almost 5000 this year.
“We know the need is likely double that. We are filling a critical gap, but we are doing it in a fragmented system.
“No mother can focus on her recovery while she is worrying about how she’s going to feed herself or her baby.”
Ms Malan said women were trying to do the right thing but often did not feel safe to ask for help.
“Many of the mothers we support are frightened of services,” she said.
“They are afraid of being seen as failing mothers and of being reported to child protection and then losing their baby. So they don’t ask even for the basics.
“That is why we go out into the community and offer support. When a mother is met without judgment, she starts to trust, and referral pathways, mental health support, and education start to work.”
But Ms Malan said frontline staff were often fearful of policy, of risk, and of leadership.
“That fear takes precedence over humanity. These are good people working in systems that reward caution over care. Mothers feel that hesitation, and it confirms their fear.”
Ms Malan made three recommendations to the inquiry:
1. That practical perinatal support be recognised as part of perinatal and postnatal healthcare in Commonwealth and state policy and funding, including for mothers whose babies are removed at birth or who experience pregnancy loss or stillbirth.
“Support like ours needs to be embedded in the system and funded as the essential service it is, rather than relying on inconsistent fundraising,” Ms Malan said.
2. Better data collection and research on the real psychosocial and economic circumstances of perinatal families.
“Current data shows what happens clinically, not the hardships mothers face once they go home.”
3. Clear, streamlined referral pathways that bring clinical care and community support together, so women and front frontline workers know exactly where to turn.
“That support should be consistent wherever a woman lives and whatever she is experiencing.
“Frontline staff should also be supported to meet immediate needs, including formula for families in crisis. Breastfeeding should be supported, but no mother should be left without a way to feed her baby.”
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Vivianne Kissane, CEO of Queensland mental health service for parents Peach Tree Perinatal Wellbeing, said referrals to their service had increased by 25% every year.
“We now receive over 1,500 referrals just in the Brisbane area, and 65% of them are coming from health professional referrals.
“Complexity is definitely increasing. We are seeing more and more psychosocial issues that are impacting on mental health and distress … issues such as domestic and family violence, food insecurity, alcohol and other drugs, suicidality.
“A lot of people who are coming to us in psychosocial distress actually aren’t meeting thresholds for a clinical diagnosis but are still experiencing distress.”
Cost of living was also having an impact, Ms Kissane said.
“We are finding that mothers are having to return to work sooner, and therefore services are more inaccessible for them.”
Systemic barriers to midwifery care
Embrace Midwifery Services director Cassie Stichel told the hearing that systemic barriers directly affected the ability of midwives to provide care to women.
In South Australia, there is a policy framework for privately practicing midwives to obtain hospital credentialing and admitting rights within their local health networks, she said.
“However, having this policy does not guarantee the consistent implementation,” Ms Stichel said.
“Despite two years of our organisation having applications in at the tertiary hospitals, we have not yet been able to secure a position with credentialing at any of the local health networks.
“The consequence is that women that require hospital care lose their access to their chosen midwife, so they don’t have their primary care provider providing that support.
“Women are admitted under the public as a public patient, and responsibility for their clinical care is handed over at the door.
“The private midwife will remain present during the labour and birth and provide emotional and practical support throughout their journey, but we’re not working to our full scope of practice and effectively reduced to the role of a support person.
“This is not genuine continuity of care, nor is it meaningful collaboration between maternity care providers.
“We need transparent, consistent credentialing processes and genuine collaboration between midwives and public hospitals.”
Ms Stichel said another barrier was the 1 January end to exemptions from professional indemnity insurance for private practicing midwives attending home births.
“A home birth requires two midwives, yet the cost of eligibility requirements and insurance risk is making it increasingly difficult to maintain this workforce.”
The practical consequences of this change will be significant, Ms Stichel said.
“The insurance requirements will reduce the amount of women that midwives will actually be able to care for, because there will need to be a second midwife for those already being cared for within the service.
“In some regional areas where there is only one endorsed midwife, this could eliminate those services and access to private midwifery care already.”
Ms Stichel said Medicare funding created another barrier, because while Medicare provides rebates for antenatal and postnatal midwifery services, there are no current intrapartum Medicare benefits for planned home birth.
“Without credentialing and admitting rights to the public hospitals, women accessing our services have no Medicare rebate available for the birth component of their care.
“Medicare funding should recognise the care being provided rather than the location in which it actually occurs.
“Women should not be financially disadvantaged simply because of the setting in which they choose to give birth.”
In a submission to the inquiry, Adelaide Mums and Babies Clinic said “time is healthcare”.
A survey of more than 300 women who used the service found that 65% wanted longer appointments to discuss concerns.
Women told the service they need time, continuity, trained clinicians, evidence-based information, mental health support, and support with breastfeeding and pelvic care.
“They need these services to be accessible without requiring substantial private expenditure,” the submission said.
“Women should not need to be unusually knowledgeable, financially privileged or persistent to obtain appropriate postnatal care.
“Postnatal care is not an optional extra after maternity care. It is maternity care.
“Significant and sustained government investment is required to make comprehensive postnatal care affordable for families, viable for services and sustainable for the workforce.”
In their submission, Adelaide Mums and Babies Clinic called for reforms to:
- Establish a national model of comprehensive postnatal care
- Reform Medicare funding for postnatal care
- Establish multidisciplinary Postnatal Care Hubs
- Improve access to breastfeeding and infant-feeding care
- Make maternal mental health and pelvic health routine components of postnatal care
- Improve antenatal preparation for the postnatal period
- Develop national postnatal clinical guidance and data collection
- Ensure postnatal care is accessible regardless of ability to pay.