Primary maternity care reform : whose influence is driving the change?

Abstract: Background: in 2009 the Australian government announced a programme of reform that will change the way maternity services have traditionally been delivered. A shift to a primary maternity care model has occurred despite strong challenges from medicine and a general public that has embraced high technology in all aspects of life including childbirth. Aim: a critical analysis was undertaken for the purpose of identifying discourses that have influenced the direction of the Australian maternity care reform agenda. Method: within a critical discourse analysis framework data were collected from state, territory and commonwealth government policy documents, and selected written submissions from national key stakeholder organisations to the National Review of Maternity Services 2008. Findings: three discourses influencing the direction of the reform are described, these include the following: ‘Australia is one of the safest place to give birth or to be born, but not for everyone’; ‘maternity care is primarily about mothers and babies, not about the service or the health professionals’ and ‘government must ensure provision of safe and sustainable maternity services’. Conclusion: the Australian government has strong support for the primary maternity care reform backed by a strong key stakeholder alliance involving consumers, midwives and rural doctors. On the contrary to the position of the key stakeholder alliance, the obstetric position has been unable to provide government with solutions to escalating costs and workforce deficits in the delivery of safe and sustainable maternity services. Consumers, rural doctors, midwives and government all agree on the need to safeguard excellent safety and quality standards whilst at the same time reducing high levels of medical intervention and providing options for care in a reformed maternity service designed to meet the needs of all Australian women.