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