Publications

The NSW Government tabled its response to the final report published by the NSW Parliament Select Committee on Birth Trauma on 29 August 2024 [1]. In its response, the Government acknowledged that some women experience birth trauma, which may be physical, psychological, or both [2]. Of the 43 recommendations aimed at addressing preventable birth trauma, the Government supported 42 either in full or in principle, with one recommendation noted.

Government’s Response to Recommendations

Part 3 of this series examined some key recommendations made by the Committee to the Government. The Government’s response to those recommendations is outlined below:

i. Recommendation 4 was supported in principle. While the Government indicated that no immediate legislative changes to the Civil Liability Act 2002 (NSW), which governs laws relating to negligence, are planned, it committed to monitoring the healthcare sector to determine whether changes are required. The Government indicated that it would consider supporting further research into the benefits and difficulties of legislative reform relating to birthing experiences and medical negligence [3]

ii. Recommendation 5 was supported in principle. The Government noted that its commitment to supporting women’s mental health during pregnancy and the postnatal period aligns with Connecting, Listening and Responding: A Blueprint for Action – Maternity Care in NSW. It noted that all women are offered universal screening through the SAFE START program, which aims to identify women who may require specialised care such as referrals to social workers, psychologists, and perinatal and infant mental health services. The Government noted that it has invested in two new Mother and Baby Units at Royal Prince Alfred and Westmead Hospitals and is working with the Australian Government to enhance mental health screening under the Bilateral Mental Health and Suicide Prevention Schedule (2022-2026). It indicated that it would advocate for a review of Medicare rebates for mental health services to better support women’s needs [4].

iii. Recommendation 8 was supported in principle. The Government noted that it continues to support medical research by funding health system research priorities through the NSW Health Translational Research Grant Scheme, which supports practice-based research projects that can be translated into policy and practice. It encouraged the development of new models of care to improve maternity services, through a competitive, merit-based process [5].

iv. Recommendation 16 was supported. The Government indicated that it would undertake a review of existing legislation, taking into account practices in comparable jurisdictions [6].

v. Recommendation 17 was supported. The Government noted it provides consent training to all NSW Health clinicians through My Health Learning, as well as local training and in-services. It indicated that NSW Health will continue to explore opportunities to refine and implement consent training specifically for maternity clinicians [7].

vi. Recommendation 19 was supported. The Government noted that reviews of NSW Health state-wide policies and guidelines occur regularly as part of the policy cycle or when changes in evidence or clinical practice arise. It indicated that it would review all state-wide policies and guidelines related to birthing interventions to ensure they align with the NSW Health Consent to Medical and Healthcare Treatment Manual and are evidence-based. The Government acknowledged that local health districts may develop local protocols and procedures to support implementation of state-wide policy documents, which must remain consistent with relevant state-wide policy documents [8].

vii. Recommendation 31 was supported in principle. The Government indicated its commitment to strengthening midwifery leadership across the Ministry of Health, local health districts, and specialty health networks. It noted that the NSW Health Maternity Co-Leadership model engages senior midwife representatives from each local health district with Ministry of Health priorities to enhance safety and quality of maternity care [9].

viii. Recommendation 35 was supported in principle. The Government indicated its commitment to ensuring all families experiencing pregnancy or neonatal loss receive respectful, individualised bereavement care. It noted that an NSW Health Perinatal Loss Guideline is in development, focusing on care across all settings regardless of pregnancy loss gestation or location. The Government acknowledged that where dedicated bereavement spaces are unavailable, alternative private areas should be identified in consultation with the woman. It noted that the Australasian Health Facility Guidelines were updated in 2023 to include specific detail about bereavement spaces for parents experiencing miscarriage or stillbirth [10].

ix. Recommendation 42 was supported. The Government noted that the NSW Health experience team has begun developing new state-wide guidelines for managing and responding to patient feedback, including a review of the Complaints Management Policy Directive. It noted that NSW Health is reviewing maternity feedback processes to better understand what matters to women, including their health and wellbeing outcomes. The review includes developing maternity-specific patient-reported measures to inform service quality and improvement. The Government indicated that it is reviewing consumer information, including NSW Health websites, to ensure pathways for questions, concerns, and complaints are clear [11].

The Government has indicated that it is taking steps to address workforce and funding shortfalls in the maternity care system through several key initiatives including:

i. Allocating more than $2.5 billion over four years in the FY2023-24 NSW budget to recruiting and retaining more skilled nurses, midwives, allied health workers and clinicians. This includes $419.1 million dedicated to recruiting 1,200 additional nurses and midwives by 2025-26 to implement Safe Staffing Levels across public hospitals [12].

ii. Investing $121.9 million over five years to provide healthcare students with study subsidies [13]

iii. Doubling relocation incentives for healthcare workers moving to remote and rural areas from $10,000 to $20,000 [14]

iv. Delivering increased take-home pay for more than 50,000 healthcare workers through increased salary packaging benefits [15]

Public Response to the NSW Government’s Response

A number of individuals have expressed disappointment that the NSW Government’s response has fallen short in ensuring all women have access to continuity of care models with a known provider [16]. Alyssa Booth, Vice President of Better Births Illawarra, stated “A resounding message from the over 4,000 women that put in submissions they really wanted midwifery continuity of care so to see that the report missed the mark on that is disappointing.” [17]. Research indicates that women without continuity of care are 24% more likely to experience pre-term birth and 16% more likely to suffer pregnancy loss and neonatal death [18].

NSW Heath Minister, Ryan Park, made a historic apology to women who have not received a high standard of maternity care [19], and acknowledged that “Across NSW, the way in which maternity services are delivered is patchy and is not consistent and what we need to do as a system is try to bring up those where there are gaps.” [20].

Conclusion

While the NSW Government’s response demonstrates a commitment to addressing birth trauma through policy reforms, enhanced training, and improved support services, advocacy groups and affected women have highlighted that more action is needed to ensure consistent, high-quality maternity care across the state. The urgency of systemic reform is underscored by a national Australian Birth Experience Study which revealed that more than one in ten Australian women feel they have experienced some form of obstetric violence [21].

For further information regarding the Committee, its final report, and how to access a claim for compensation in instances of avoidable injury suffered as a result of negligent medical care, please refer to parts 1, 2, and 3 of this series.

[1] Government response – https://www.parliament.nsw.gov.au/tp/files/189254/Government%20response%20-%20Birth%20trauma.pdf

[2] Page 5 of government response

[3] Page 8 of government response

[4] Pages 9-10 of government response

[5] Page 11 of government response

[6] Pages 16-17 of government response

[7] Page 17 of government response

[8] Pages 17-19 of government response

[9] Page 24 of government response

[10] Pages 28-29 of government response

[11] Page 32 of government response

[12-15] https://www.nsw.gov.au/media-releases/initiatives-underway-to-improve-maternity-care-and-experiences

[16-17] https://www.abc.net.au/news/2024-08-29/birth-trauma-inquiry-nsw-government-response/104280902

[18] https://www.sbs.com.au/news/article/the-missing-element-in-nsws-historic-promise-to-end-birth-trauma/48225ffq2

[19] https://www.nsw.gov.au/media-releases/initiatives-underway-to-improve-maternity-care-and-experiences

[20] https://www.abc.net.au/news/2024-08-29/birth-trauma-inquiry-nsw-government-response/104280902

[21] https://journals.sagepub.com/doi/10.1177/10778012221140138