Footnotes

[1] Submission No. 69, p.7 (Women’s Hospitals Australia and Australian Healthcare Association).

[2] Submission No. 46, p.5 (The Royal Women’s Hospital, Vic).

[3] Committee Hansard, 27.8.99, p.9 (Department of Health and Aged Care).

[4] Submission No. 165, pp.7-8 and pp.1-2 (Team Midwives, John Hunter Hospital).

[5] Additional information, 24.9.99 (Community Midwifery Program, SA).

[6] Committee Hansard, 14.9.99, p.434 (Midwifery Practice and Research Centre).

[7] Submission No. 8, p.2 (Dr Andrew Child, King George V Memorial Hospital, Sydney).

[8] Submission No. 36, p.4 (Ms Clarissa Cook, Tas).

[9] National Health and Medical Research Council. Options for effective care in childbirth, 1996; Health Department of Victoria. Having a Baby in Victoria, 1990; Final Report of the Ministerial Taskforce on Obstetric Services, NSW, 1989.

[10] Submission No. 69, pp.8-9 (Women’s Hospitals Australia and Australian Healthcare Australia).

[11] Submission No. 163, p.6 (Department of Human Services, Vic). Refers to 1993 ‘Survey of Recent Mothers’ conducted in Victoria by Stephanie Brown and Judith Lumley.

[12] Committee Hansard, 6.9.99, p.134 (Maternity Coalition, Vic).

[13] For example by the NHMRC Report Options for effective care in childbirth, Canberra,1996, p. xii.

[14] Committee Hansard, 6.9.99, p.156 (Royal Women’s Hospital, Vic).

[15] Committee Hansard, 7.6.99, p.254 (Department of Human Services, SA).

[16] The Committee recognises that the majority of pregnant women are not ill and that use of the term ‘patient’ is therefore problematic. It is used here, and occasionally elsewhere in the Report, where it clarifies the issues being discussed.

[17] Figures are from Australian Institute of Health and Welfare. Medical labour force 1997, Canberra 1999, p.3 and p.29, Australian Medical Workforce Advisory Committee. The Obstetrics and Gynaecology Work Force in Australia: Supply and Requirements 1997-2008, Sydney 1998, p.8 and Australian Institute of Health and Welfare. Nursing labour force 1998, Canberra 1999, p.58.

[18] See Submission No. 97, p.31 (Department of Health and Aged Care).

[19] Submission No. 78, p.31 (Mater Misericordiae Mothers’ Hospital, Qld).

[20] Submission No. 156, p.3 (Aboriginal and Torres Strait Islander Commission). Figures issued by the Australian Bureau of Statistics in November 1999 show the infant mortality rate for indigenous Australians was at least three times the Australian rate in 1998.

[21] Trends in the health of mothers and babies, Northern Territory 1986-95, Northern Territory Midwives Collection, Territory Health Services, 1998, pp.16-18.

[22] A perinatal death is a still birth plus a death of a baby within 28 days of birth.

[23] NSW Department of Health, NSW Midwives Data Collection, 1995.

[24] Australian Bureau of Statistics and Australian Institute of Health and Welfare. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 1999, p.88.

[25] Submission No. 45, p.18 (Australian Midwifery Action Project, NSW).

[26] Powell J. and Dugdale A.E. Obstetric Outcomes in an Aboriginal Community. A Comparison with the Surrounding Rural Area. Australian Journal of Rural Health, Feb 1999, 7, pp.13-17.

[27] Department of Human Services, Koori Health Unit, 1996.

[28] Australian Bureau of Statistics and Australian Institute of Health and Welfare. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 1999, p.87.

[29] Submission No. 38, p. 15 (NSW Midwives Association).

[30] Territory Health Services, Women’s Health Unit. Evaluation of the Alternative Birthing Service Program in the Northern Territory, 1997, p.11.

[31] Health Department of Victoria. Final Report of the Ministerial Review of Birthing Services in Victoria, Having a Baby in Victoria, 1990; NHMRC. Options for effective care in childbirth, 1996; Legislative Assembly of Western Australia. Report of Select Committee on Intervention in Childbirth, 1995.

[32] Shearman, R. Final Report of the Ministerial Task Force on Obstetric Services in New South Wales, New South Wales Health Department, 1989.

[33] Submission No. 104, p.1 (Central Sydney Area Health Service).

[34] Submission No. 51, p.11 (Midwifery Practice and Research Centre, NSW).

[35] Submission No. 69, p. 32 (Women’s Hospitals Australia and Australian Healthcare Association).

[36] Committee Hansard, 7.9.99, pp.195-196 (Professor Keirse, Flinders Medical Centre).

[37] Submission No. 30, p.1 (Homebirth Network of South Australia).

[38] Committee Hansard, 8.9.99, p.364 (Australian College of Midwives, WA).

[39] Submission No.110, p.20 (Dr Sarah Buckley, Qld).

[40] Committee Hansard, 8.9.99, p.314 (Community Based Midwifery Program, WA).

[41] Ibid, p.318.

[42] Committee Hansard, 7.9.99, p.195 (Professor Keirse, Flinders Medical Centre).

[43] Submission No. 153, p.3 (Maternity Alliance, NSW).

[44] Territory Health Services, Women’s Health Unit. Evaluation of the Alternative Birthing Services Program in the Northern Territory, 1997, p.16.

[45] Dr Hilda Turnbull MLA. Select Committee on Intervention in Childbirth, Perth, 1995.

[46] Your Birth Choice. Planning Ahead for Birth. Health Department of West Australia, 1998.

[47] Committee Hansard, 8.9.99, pp.289-90 (Dr Turnbull MLA).

[48] By the West Australian Department of Health. See Committee Hansard, 8.9.99, p.352.

[49] Submission No. 153, p.15 (Maternity Alliance, NSW).

[50] Committee Hansard, 6.9.99, p.87 (Dr Jane Fisher, University of Melbourne).

[51] Submission No. 153, p.3 (Maternity Alliance, NSW).

[52] Submission No. 17, Appendix 1 (Royal Australian and New Zealand College of Obstetricians and Gynaecologists).

[53] Committee Hansard, 6.9.99, p.121 (Health Services Commissioner, Vic).

[54] Committee Hansard, 6.9.99, p.123 (Health Services Commissioner, Vic).

[55] Gilkison A. Antenatal Education - Whose Purposes Does it Serve? New Zealand College of Midwives Journal, May 1991, p.13.

[56] Committee Hansard, 14.9.99, p.398 (National Association of Childbirth Educators).

[57] See Committee Hansard, 6.6.99, p.140 (Maternity Coalition, Vic).

[58] Submission No.37, p.1 (Ms Pauline Green, National Association of Childbirth Educators).

[59] Gilkison A. Antenatal Education - Whose Purposes Does it Serve? New Zealand College of Midwives Journal, May 1991, pp.13-14.

[60] Committee Hansard, 6.6.99, p.139 (Maternity Coalition, Vic).

[61] Committee Hansard, 15.9.99, p.590 (Dr Fahy, University of Southern Queensland).

[62] Committee Hansard, 7.9.99, p.235 (Keep the Queen Elizabeth Hospital Delivering Community Action Group).

[63] Nolan M. L. Antenatal education - where next? Journal of Advanced Nursing, London,1997, 25, p.1200.

[64] Submission No. 94, p.3 (Home Midwifery Association, Qld Inc).

[65] Submission No. 69, p.9 (Women’s Hospitals Australia and Australian Healthcare Association).

[66] Submission No. 150, p.3 (Royal North Shore Hospital, NSW).

[67] Committee Hansard, 8.9.99, pp.303-304 (Professor Newman, King Edward Memorial Hospital, WA).

[68] Submission No. 70, p. 2 (Royal Australian College of General Practitioners).

[69] Submission No. 17, Appendix 1 (Royal Australian and New Zealand College of Obstetricians and Gynaecologists).

[70] See Committee Hansard, 27.8.99, p.71 (Women’s Hospitals Australia).

[71] Submission No. 38, p.4 (NSW Midwives Association).

[72] Submission No. 47, p.4 (Ms Carole Gilmour, NSW).

[73] See Committee Hansard, 27.8.99, p.73 (Women’s Health Australia).

[74] Submission No. 104, p.4 (Central Sydney Area Health Service).

[75] Submission No 16, p.3 (Royal Women’s Hospital Health Service District, Brisbane).

[76] Buckley S. Ultrasound - Reasons for Caution. First published in Australia’s Parents, Summer 1999, as All about Ultrasound.

[77] Committee Hansard, 6.9.99, p.158 (Royal Women’s Hospital, Vic).

[78] Committee Hansard, 8.9.99, p.325 (Royal Australian College of General Practitioners).

[79] Committee Hansard, 8.9.99, p.340 (Professor Michael, St John of God Health Care).

[80] Submission No. 38, p.3 (NSW Midwives Association).

[81] Health Insurance Commission Medicare Benefits Schedule Item statistics generated 5 October 1999.

[82] Submission No. 150, p.3 (Royal North Shore Hospital, NSW).

[83] Submission No. 17, p.3 (Royal Australian and New Zealand College of Obstetricians & Gynaecologists).

[84] Australian Health Technology Advisory Committee. Diagnostic Ultrasound. Discussion Paper - Forum on Ultrasound, Sydney, 13-14 June 1998, p.v. These figures are based on data from the MBS, which excludes public patients in the public health system.

[85] Ibid, p.46.

[86] Buckley S. Ultrasound - Reasons for Caution. First published in Australia’s Parents, summer 1999, as All about Ultrasound.

[87] Committee Hansard, 15.9.99, p.513 (Professor James King).

[88] Australian Health Technology Advisory Committee. Diagnostic Ultrasound, Discussion Paper - Forum on Ultrasound, Sydney 13-14 June 1998, p.42.

[89] See Sparling J. W. et al. The relationship of obstetrical ultrasound to parent and infant behaviour. Obstetrical Gynaecology 1988, vol. 72, no. 6, pp.902-7.

[90] Committee Hansard, 7.9.99, p.202 (Professor Marshall, Flinders Medical Centre).

[91] Buckley S, What’s new in prenatal diagnosis, p.3, 1998. Attachment to Submission No. 110.

[92] Submission No. 7, p.1 (Ms Jenny Parratt, Vic).

[93] From Wagner M. Ultrasound: More Harm than Good? ACE Graphics, 2 November 1998, p.1.

[94] Ewigman B.G. et al. The Effect of Prenatal Ultrasound Screening on Perinatal Outcome. New England Journal of Medicine, 16 September 1993: 329, pp.821-827.

[95] Neilson J. P. Ultrasound for fetal assessment in early pregnancy. Cochrane Review. In Cochrane Library, Issue 3, 1999, Oxford: Update Software.

[96] Committee Hansard, 8.9.99, p.308 (Professor Newnham, King Edward Memorial Hospital, WA).

[97] Submission No. 38, pp.3-4 (NSW Midwives Association).

[98] Buckley S. What’s new in prenatal diagnosis, 1998. Attachment to Submission No. 110.

[99] Submission No. 5, p.1 (Dr B R Pridmore, Queen Elizabeth Hospital, SA).

[100] Submission No. 150, p.4 (Royal North Shore Hospital, NSW).

[101] Submission No. 110, p.4 (Dr Sarah Buckley, Qld).

[102] Ibid, p.4.

[103] The Committee notes the reservations expressed by the NHMRC on the use of this term (ie that it may encourage the view that maternity services are a set of alternative systems run by competing professional groups rather than an integrated set of options.) However, it considers the term is in such general use and so widely understood as to justify its use in this Report.

[104] Australian Institute of Health and Welfare. Australia’s mothers and babies 1996, p.5.

[105] Ibid, p.5.

[106] Submission No. 97, p.5 (Department of Health and Aged Care).

[107] de Looper M. Kuldeep B. International health - how Australia compares, Australian Institute of Health and Welfare, Canberra, 1999, p.25.

[108] Australian Bureau of Statistics, 1999 Causes of Death, Australia.

[109] Australian Institute of Health and Welfare. Australia’s mothers and babies 1996, p.xiv and Australian Bureau of Statistics 1999. Causes of Death, Australia. Perinatal deaths are stillbirths plus neonatal deaths. Neonatal deaths are those of babies within 28 days of birth. Foetal, neonatal and perinatal deaths are normally given per 1,000 births. Maternal deaths are given per 100,000 births because total numbers are so small.

[110] Ibid, p.6.

[111] Ibid, p.13.

[112] Brown Stephanie, Lumley Janet. Changing childbirth: lessons from an Australian survey of 1330 women, British Journal of Obstetrics and Gynaecology, February 1998, vol. 105, p.152.

[113] Submission No. 34, p.1 (Westmead Hospital, NSW).

[114] Submission No. 38, p.10 (NSW Midwives Association).

[115] See for example Submission No. 165, p.5 (Team Midwives, John Hunter Hospital) and Submission No.180, p.1 (Ms Katrina Maranik, NSW).

[116] Committee Hansard, 6.9.99, p.103 (Australian College of Midwives Inc, Vic Branch).

[117] Submission No. 15, p.13 (Dr Kathleen Fahy and Dr Karen Lane, University of Queensland).

[118] See Submission No. 62, p.9 (Australian College of Midwives, WA).

[119] Submission No. 153, p.10 (Maternity Alliance, NSW).

[120] See Submission No. 14, p.12 (Australian College of Midwives Inc, Vic).

[121] Committee Hansard, 7.9.99, p.206 (Perinatal Society of Australia and New Zealand).

[122] Figures are from Australian Institute of Health and Welfare. Australia’s mothers and babies 1996, p.5.

[123] Additional information, 30.10.99 (Queensland Health).

[124] Committee Hansard, 7.9.99, p.226 (Birth Matters, SA).

[125] Submission No. 62, p.8 (Australian College of Midwives, WA).

[126] Committee Hansard, 8.9.99, p.364 (Australian College of Midwives).

[127] Additional information 21.10.99 (Health Department of Western Australia).

[128] Territory Health Services, Women’s Health Unit. Evaluation of the Alternative Birthing Services Program in the Northern Territory, 1997, p.iv.

[129] Submission No. 62, p.12 (Australian College of Midwives, WA).

[130] Committee Hansard, 6.9.99, p.145 (Royal Women’s Hospital, Vic).

[131] Ibid, p.145.

[132] These include: NHMRC. Options for effective care in childbirth, 1996. Health Department of Victoria. Having a Baby in Victoria, 1990. West Australian Legislative Assembly. Report of Select Committee on Intervention in Childbirth, 1995. NSW Health Department. Final Report of Ministerial Taskforce on Obstetrical Services in New South Wales, 1989.

[133] Throughout this Report the term home birth is used only to indicate planned home births, whether they are completed there or in a hospital setting.

[134] Committee Hansard, 27.8.99, p.26 (Australian Institute of Health and Welfare).

[135] See Submission No. 15, p.9 (Dr Kathleen Fahy and Dr Karen Lane, University of Queensland).

[136] Submission No.18, pp.2-3 (Dr Ron Chang and other medical specialists, Qld).

[137] Submission No. 17, p.7 (Royal Australian College of Obstetricians and Gynaecologists).

[138] Submission No. 20, p.7 ( Ms Robin Payne, Choices for Childbirth, Vic).

[139] Submission No. 30, p.4 (Homebirth Network of South Australia).

[140] Mardi Chapman. Homebirth Control. Australian Doctor, 29 January 1999, p.34. The findings of the study referred to were published in the Medical Journal of Australia 1990, 153: pp.664-71.

[141] Submission No. 81, p.4 (Launceston Birth Centre Inc).

[142] Committee Hansard, 15.9.99, p.561 (Association for Improvement in the Maternity Services, Qld).

[143] Submission No. 123, p.2 (Ms Lisa Joseph, NSW).

[144] Submission No. 171, p.6 (Birthplace Support Group Inc, WA).

[145] Submission No. 36, p.6 (Ms Clarissa Cook, Tas).

[146] Submission No. 20, pp.7-8 and 11 (Ms Robin Payne, Choices for Childbirth, Vic).

[147] Olsen Ole. Meta-analysis of the Safety of Home Birth. Birth, 24: 1 March 1997, p.11. This study examined the birth outcomes for 24,092 primarily low risk women in six controlled, observational studies.

[148] Bastian H. Keirse J. N. C. Lancaster P. A. L. Perinatal deaths associated with planned home birth in Australia: population based study. British Medical Journal, vol. 317, 8 August 1998, pp. 384-387.

[149] Ibid.

[150] Submission No. 15, p.9 (Dr Kathleen Fahy and Dr Karen Lane, University of Qld) Figures quoted are from Bastian H. and Lancaster P. A. L. Home Births in Australia 1998-1990. AIHW National Perinatal Statistics Unit, Sydney, 1992.

[151] Submission No. 153, p.11 (Maternity Alliance, NSW).

[152] Committee Hansard, 14.9.99, p.497 (Dr A.F.Pesce, Westmead Hospital).

[153] Committee Hansard, 27.8.99, p.25 (Australian Institute of Health and Welfare).

[154] Submission No. 5, p.2 (Dr B.R. Pridmore, Queen Elizabeth Hospital, Adelaide).

[155] Submission No. 70, p.4 (Royal Australian College of General Practitioners). The study referred to is by Hogg W. E. et al. The Case for Small Rural Hospital Obstetrics. Canadian Family Physician 32: pp.2135-38, October 1986.

[156] Submission No. 70, p.4 (Royal Australian College of General Practitioners).

[157] Committee Hansard, 8.9.99, p.293 (Dr Turnbull, MLA).

[158] New South Wales Health Department. New South Wales Mothers and Babies 1997, Sydney 1998, p.88.

[159] National Health and Medical Research Council. Options for effective care in childbirth, p.12, Canberra 1996.

[160] Committee Hansard, 8.9.99, p.323 (Royal Australian College of General Practitioners).

[161] Submission No. 70, p.5 (Royal Australian College of General Practitioners). The NSW study referred to is by Woollard L. A. and Hays R. Rural Obstetrics in NSW. Australian and New Zealand Journal of Obstetrics and Gynaecology, 33:3 pp.240-42, 1993.

[162] Submission No. 65, p.1 ( Dr Joanna McCubbin, Vic).

[163] Innes, Kathleen M. Why are general practitioners ceasing obstetrics? Medical Journal of Australia, vol. 166, 3 March 1997.

[164] Ibid, p.2.

[165] Committee Hansard, 8.9.99, p.330 (Royal Australian College of General Practitioners).

[166] Australian Institute of Health and Welfare. Nursing labour force 1998, Canberra 1999, p.58.

[167] Submission No. 69, p.31 (Women’s Hospitals Australia and Australian Healthcare Association).

[168] See Submission No. 97, p.31 (Department of Health and Aged Care).

[169] In Submission No. 150, pp.11-12.

[170] Submission No. 97, p.33 (Department of Health and Aged Care).

[171] Committee Hansard, 8.9.99, p.294 (Dr Hilda Turnbull, MLA).

[172] See Australian Institute of Health and Welfare. Indigenous mothers and their babies Australia 1994-1996, Sydney 1999, p.12.

[173] Australian Institute of Health and Welfare. Australia’s mothers and babies, 1996, Canberra, 1999.

[174] Ibid, p.19.

[175] Committee Hansard, 27.8.99, p.19 (Australian Institute of Health and Welfare).

[176] National Hospital Morbidity (Casemix) Database 1997-98. The Department of Health and Aged Care cautions that the data ‘has not yet been subjected to the extensive analysis that has been applied to the data from the AIHW’. See Submission No. 97, p.17 (Department of Health and Aged Care).

[177] Australian Institute of Health and Welfare. Australia’s mothers and babies 1996, Canberra, 1999, p.19.

[178] Submission No. 97, p.17 (Department of Health and Aged Care).

[179] Lancaster Paul A L & Pedisich Elvis L. Caesarean births in Australia, 1985-1990, Australian Institute of Health and Welfare National Perinatal Statistics Unit, Sydney 1993, pp.6-9.

[180] Committee Hansard, 27.8.99, p.19 (Australian Institute of Health and Welfare).

[181] Committee Hansard, 6.9.99, p.92 (Dr Jane Fisher, University of Melbourne).

[182] Cotzias C, Fisk N. Patient demand for Caesarean section. Advances in Obstetrics and Gynaecology, Issue 15, p.9.

[183] Submission No. 97, p.20 (Department of Health and Aged Care).

[184] Lancaster A. L. & Pedisich Elvis L. Caesarean births in Australia, 1985-1990. Australian Institute of Health and Welfare National Perinatal Statistics Unit, Sydney, 1993, p.10.

[185] Committee Hansard, 6.6.99 p.85 (Dr Jane Fisher, University of Melbourne).

[186] Submission No. 170, p. 6 (Australian Institute of Health and Welfare).

[187] Additional information 27.8.99 (Women’s Hospitals Australia).

[188] Additional information 7.9.99 (Mercy Hospital for Women, Melbourne).

[189] Submission No. 93. p.5 (Central Coast Midwives Association).

[190] New South Wales Health Department. New South Wales Mothers and Babies 1997, Sydney, 1998, pp.88‑89.

[191] Committee Hansard, 27.8.99, p.8 (Australian Institute of Health and Welfare).

[192] Committee Hansard, 14.9.99, p.397 (Professor M Chamberlain, University of Sydney).

[193] Committee Hansard, 27.8.99, p.29 (Australian Institute of Health and Welfare).

[194] Committee Hansard, 8.9.99, pp.321-22 (Royal Australian College of General Practitioners).

[195] National Health and Medical Research Council. Report on Maternal Deaths in Australia 1991-1993, Canberra 1998, p.9 and p.68.

[196] Hilder L et al. Prolonged pregnancy: evaluating gestation specific risks of fetal and infant mortality. British Journal of Obstetrics and Gynaecology, 1998;105: pp.169-173.

[197] Figures are from Australian Institute of Health and Welfare. Australia’s mothers and babies 1996, Sydney 1999, p.7.

[198] Submission No. 170, p.3 (Australian Institute of Health and Welfare).

[199] Ibid, p.3.

[200] See de Costa Caroline M. Caesarean section: a matter of choice? Medical Journal of Australia 23.5.99, 170, pp.572-573.

[201] Quinlivan J. Peterson R. and Nichols C. Patient Preference the Leading Indication for Elective Caesarean Section in Public Patients - Results of a 2-year prospective audit in a teaching hospital. Australian and New Zealand Journal of Obstetric Gynaecology, 1999, 392, pp. 207-214.

[202] Australian Institute of Health and Welfare. Australia’s mothers and babies 1996, Sydney 1999, p.18.

[203] See Schiff et al. Maternal and Neonatal Outcomes of 846 Singleton Breech Deliveries. American Journal of Obstetrics and Gynaecology 1996, 175, pp.18-23.

[204] Australian Institute of Health and Welfare. Australia’s mothers and babies 1996, pp.43-44.

[205] Committee Hansard, 6.9.99, p.172 (Royal Australian and New Zealand College of Obstetricians and Gynaecologists).

[206] Submission No. 170, p.5 (Australian Institute of Health and Welfare).

[207] Submission No. 154, p.4 (Professor Marie Chamberlain and Ms Jannine van der Klei).

[208] Submission No.184, p.2 (Birth Support, Bendigo).

[209] Committee Hansard, 6.9.99, p.175 (National Association of Specialist Obstetricians and Gynaecologists).

[210] Removing the uncertainty. Adelaide Advertiser, 6.9.99.

[211] Caesareans - Just what the Mother-to-be Ordered. Australian, 28.8.99, p.3.

[212] Committee Hansard, 15.9.99, p.526 (Dr Sarah Buckley).

[213] Committee Hansard, 7.9.99, p.269 (Sister Edith Reddin).

[214] See Turnbull Deborah A et al. Women’s role and satisfaction in the decision to have a caesarean section. Medical Journal of Australia 1999; 170, pp.580-583.

[215] Cotzias C. Fisk N. Patient demand for a Caesarean section. Advances in Obstetrics and Gynaecology. Issue 15, pp.11-12.

[216] Handa V. L. et al. Protecting the pelvic floor; obstetric management to prevent incontinence and pelvic floor prolapse. Obstetrics and Gynaecology 1996, September: 88 (3), pp.470-478.

[217] Submission No. 188, p.1 (Dr Glen Barker, Vic).

[218] Ibid, p.12.

[219] Committee Hansard, 7.9.99, p.265 (Dr Deborah Turnbull, University of Adelaide). Referring to study by Turnbull, Deborah A. Women’s role and satisfaction in the decision to have a Caesarean section. Medical Journal of Australia 1999, 170: pp.580-583.

[220] Committee Hansard, 7.9.99, p.269 (Sister Edith Reddin).

[221] Submission No. 57, p.2 (Brisbane Independent Midwives). The research referred to is by D Creedy, and was published as Birthing and the development of trauma symptoms: incidence and contributing factors. Griffith University, Brisbane 1999.

[222] Cotzias C. Fisk N. Patient demand for a Caesarean section. Advances in Obstetrics and Gynaecology. Issue 15. p13. Article refers to a number of studies on this issue including Greene R et al. Long-term implications of caesarean section. American Journal of Obstetrical Gynaecology 1997, 176, pp.254-256 and Coulter- Smith S et al. Previous caesarean section: a risk factor for major obstetric haemorrhage, Journal of Obstetrics and Gynaecology, 1996, 16, pp. 349-352.

[223] Submission No. 184, pp. 1-2 (Birth Support Bendigo).

[224] Cotzias C. Fisk N. Patient demand for a Caesarean section. Advances in Obstetrics and Gynaecology, Issue 15, p.10.

[225] This was a Melbourne study conducted by Dr Jane Fisher in 1993. It analysed questionnaires sent to 242 nulliparous pregnant women in the late stages of pregnancy and again six weeks after birth.

[226] Fisher J et al. Private health insurance and a healthy personality: new risk factors for obstetric intervention? Journal of Psychosomatic Obstetrics and Gynaecology, 16, 1995, p.6.

[227] Committee Hansard, 7.9.99, p.265 (Dr D Turnbull, University of Adelaide).

[228] Committee Hansard, 7.9.99, pp. 266-7 (Dr D Turnbull, University of Adelaide).

[229] Turnbull Deborah A. et al. Women’s role and satisfaction in the decision to have a caesarean section. Medical Journal of Australia 1999; 170: pp.580-583.

[230] See Wilkinson C, et al. Is a rising caesarean section rate inevitable? British Journal of Obstetrics and Gynaecology 1998, vol. 105, pp.45-52 and Quinlivan J et al. Patient Preference the Leading Indication for Elective Caesarean Section in Public Patients - Results of a 2-year prospective audit in a teaching hospital. Australian and New Zealand Journal of Obstetrics and Gynaecology, 1999, vol. 392, pp. 207-214.

[231] Committee Hansard, 6.9.99, p.174 (National Association of Specialist Obstetricians and Gynaecologists).

[232] Committee Hansard, 6.9.99, p.85 (Dr Jane Fisher, University of Melbourne).

[233] Committee Hansard, 7.9.99, p.200 (Professor M Keirse, Flinders Medical Centre).

[234] Committee Hansard, 27.8.99, p.68 (Women’s Hospitals Australia).

[235] Committee Hansard, 7.9.99, p.195 (Professor M Keirse, Flinders Medical Centre).

[236] Hall M H. When a woman asks for a caesarean section. British Medical Journal 1987; 294: pp.201-202.

[237] Committee Hansard, 6.9.99, p.170 (National Association of Specialist Obstetricians and Gynaecologists).

[238] Paterson-Brown S. Should doctors perform an elective caesarean section on request? British Medical Journal, vol. 317, 15 August 1998, p.463.

[239] Olubusola Amu et al. Maternal choice alone should not determine method of delivery. British Medical Journal, vol. 317, 15 August 1998, pp. 462-463.

[240] Additional Information 7.9.99 (Mercy Hospital for Women, Melbourne).

[241] Committee Hansard, 6.9.99, p.170 (National Association of Specialist Obstetricians and Gynaecologists).

[242] Commonwealth Department of Human Services and Health. Compensation and Professional Indemnity in Health Care. A Final Report, Canberra 1995, p.281. The same Report noted (p.10) that ‘80% of the cases numerically made against obstetricians and gynaecologists related to their gynaecological practice’.

[243] The West Australian. Doctors pay a price for medical progress, 27 January 1994, p.11.

[244] Committee Hansard, 7.9.99, p.194 (Professor M Keirse, Flinders Medical Centre).

[245] Committee Hansard, 6.9.99 p.92 (Dr Jane Fisher, University of Melbourne).

[246] The West Australian Health Department, for example, advised that in a West Australian tertiary hospital an uncomplicated vaginal delivery costs $1776 and an uncomplicated Caesarean section costs $2640. The cost of each is significantly lower in non teaching hospitals. Additional information 21.10.99.

[247] What is the right number of caesarean sections? Lancet editorial 1997; 348, p. 815.

[248] Cotzias C. Fisk N. Patient demand for Caesarean section. Advances in Obstetrics and Gynaecology, Issue 15, p.13.

[249] Paterson-Brown S. Should doctors perform an elective caesarean section on request? British Medical Journal vol. 317, 15 August 1998, p.463.

[250] World Health Organisation. Appropriate Technology for Birth. 1985. Sometimes referred to as the Fortelesa Declaration.

[251] Health Department of Victoria. Having a baby in Victoria. Final Report of the Ministerial Review of Birthing Services in Victoria, Melbourne 1990, p.91.

[252] These and other figures in the following paragraphs are from Submission No. 170, p.2 (Australian Institute of Health and Welfare) and Submission No. 97, p.19 (Department of Health and Aged Care).

[253] In an attachment to Submission No. 78, p.13 (Mater Misericordiae Mothers’ Hospitals, Brisbane).

[254] See Submission No. 69, p.16 (Women’s Hospitals Australia and Australian Healthcare Association).

[255] Submission No. 38, p.7 (NSW Midwives Association).

[256] Committee Hansard, 27.8.99, p.40 (Women’s Electoral Lobby).

[257] Submission No. 5, p.2 (Dr B.R. Pridmore, Queen Elizabeth Hospital, Adelaide).

[258] See Submission No. 154, p.6 (Professsor M Chamberlain & Ms Janine van der Klei, University of Sydney).

[259] Submission No. 110, p.11 (Dr Sarah Buckley, Qld).

[260] Australian Institute of Health and Welfare. Australia’s mothers and babies 1996, p.68.

[261] New South Wales Health Department. New South Wales Mothers and Babies 1997, Sydney 1998, pp.85-86. The document lists all hospitals with more than 200 deliveries annually.

[262] Thornton Jim G. Active management of labour, Current Opinion in Obstetrics and Gynaecology, vol. 9, no. 6, December 1997, p.366.

[263] Ibid, p.367.

[264] Submission No. 110, p.12 (Dr Sarah Buckley, Qld).

[265] Submission No. 97, p.19 (Department of Health and Aged Care).

[266] Submission No. 179, p.2 (Health Department of Western Australia).

[267] Submission No. 51, p.6 (Midwifery Practice and Research Centre, NSW).

[268] Submission No. 97, p.20 (Department of Health and Aged Care).

[269] Submission No. 179, p.3 (Health Department of Western Australia).

[270] Submission No. 109, p.8 (NSW Pregnancy and Newborn Services Network and Centre for Perinatal Health Services Research).

[271] See Buckley, Dr Sarah. Epidurals - real risks for mother and baby, Australia’s Parents Aug/Sept 1998, entitled All about epidurals.

[272] Submission No. 17, p.6 (Royal Australian College of Obstetricians and Gynaecologists).

[273] Zhang Jun et al. Epidural analgesia in association with duration of labour and mode of delivery. A quantitative review. American Journal of Obstetrics and Gynaecology, vol.18 (4) April 1999, p.970.

[274] Jacobsen B. et al Opiate addiction in adult offspring through possible imprinting after obstetrical treatment. British Medical Journal, 10 Nov 1990, vol.301, pp.1067-70.

[275] Haire, Doris. Medications used in Labour and their effects on Mother and Newborn. Paper presented at UNICEF Birth without Boundaries conference, Chiang Mai, Thailand, 1 March 1997.

[276] Submission No. 14, Appendix 2 (Australian College of Midwives Inc, Vic).

[277] Shorten Allison and Shorten Brett. Episiotomy in NSW hospitals 1993-1996: Towards understanding variations between public and private hospitals. Australian Health Review, Vol.22, No. 11, p.25.

[278] Ibid, p.25.

[279] See Chamberlain Geoffrey and Steer Philip. Operative delivery. British Medical Journal, vol. 318, May 1990, pp.1260-1264.

[280] See Sachs B.P. et al. The Risk of Lowering the Caesarean-Delivery Rate, New England Journal of Medicine, 7 Jan 1999, vol. 340 pp.54-57.

[281] Submission No. 97, p.23 (Department of Health and Aged Care). Refers to a study by Brown S. and Lumley J. Maternal health after childbirth: result of an Australian based survey. British Journal of Obstetrics and Gynaecology, February 1998, 105 (2), pp.156-161.

[282] Ibid, p.19.

[283] Ibid, p.20.

[284] Shorten Allison and Shorten Brett. Episiotomy in NSW Hospitals 1993-1996: Towards understanding variations between public and private hospitals. Australian Health Review, vol. 22, no.1 1999, p.22.

[285] Submission No. 89, p.7 (Catholic Health Australia).

[286] See Submission No. 69, p.16 (Women’s Hospitals Australia and Australian Healthcare Association).

[287] Submission No. 38, p.7 (NSW Midwives Association).

[288] Ibid, p.7.

[289] National Health and Medical Research Council. Options for effective care in childbirth, 1996, p.8.

[290] Committee Hansard, 27.8.99 (Australian Institute of Health and Welfare).

[291] Submission No. 46, p.2 (Royal Women’s Hospital, Vic).

[292] Submission No.104, p.5 (Central Sydney Area Health Service).

[293] Submission No. 5, p.1 (Dr B.R. Pridmore, Queen Elizabeth Hospital, Adelaide).

[294] National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical best practice guidelines, Canberra 1999, p.9.

[295] Submission No. 109, p.19 (NSW Pregnancy and Newborn Services Network and Centre for Perinatal Health Services Research).

[296] Committee Hansard, 6.9.99, p.158 (Royal Women’s Hospital, Vic).

[297] Submission No. 51, p.12 (Midwifery Practice and Research Centre, NSW).

[298] Submission No. 163, p.6 (Department of Human Services, Vic).

[299] Submission No. 171, pp.1-2 (Birthplace Support Group Inc).

[300] Submission No. 18, p.2 (Dr Ron Chang and others, Qld).

[301] Submission No. 147, p.4 (Mr and Mrs J. Wade, Qld).

[302] Submission No. 70, p.5 (Royal Australian College of General Practitioners).

[303] Submission No. 51, p.4 (Midwifery Practice and Research Centre, NSW).

[304] Taken from NHMRC. A guide to the development, implementation and evaluation of clinical practice guidelines, Canberra 1999, p.56.

[305] Ibid, p.10.

[306] Committee Hansard, 6.6.99, p.162 (Royal Women’s Hospital, Vic).

[307] Submission No. 69, p.12 (Women’s Hospitals Australia and Australian Healthcare Association).

[308] Committee Hansard, 14.9.99, p.412 (Health Advisory Committee of NHMRC).

[309] Submission No. 48, p.10 (Australian College of Midwives Inc, Goldfields Sub-Branch).

[310] Committee Hansard, 6.6.99, p.158 (Royal Women’s Hospital, Vic).

[311] Committee Hansard, 6.6.99, p.171 (Royal Australian and New Zealand College of Obstetricians and Gynaecologists).

[312] Committee Hansard, 27.8.99, p.59 (Women’s Hospitals Australia).

[313] Committee Hansard, 14.9.99, p.421 (Health Advisory Committee of NHMRC).

[314] Submission No. 56, p.5 (Association for Improvement in Maternity Services, Qld).

[315] Committee Hansard, 6.9.99, p.127 (Health Services Commissioner, Victoria).

[316] Committee Hansard, 14.9.99, p.384 (Australian Midwifery Action Project, NSW).

[317] Committee Hansard, 14.9.99, p.386 (Professor M Chamberlain, University of Sydney).

[318] National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines, Canberra, 1999, p.2.

[319] See A guide to the development, implementation and evaluation of clinical practice guidelines, referred to above. Other NHMRC publications on related topics include, for example, the Report of the Health Care Committee Expert Panel on Perinatal Morbidity, 1995, which discussed best practice in prevention and management of perinatal morbidities and Care around Preterm Birth - Clinical Practice Guidelines.

[320] Women’s and Children’s Hospital, Adelaide. Perinatal Protocols and Guidelines for Management, 1996.

[321] National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines, Canberra 1990, p.1.

[322] Committee Hansard, 14.9.99, p.459 (NSW Pregnancy and Newborn Services Network).

[323] Committee Hansard, 14.9.99, p.473 (NSW Pregnancy and Newborn Services Network).

[324] Submission No. 109, pp.19-20 (NSW Pregnancy and Newborn Services Network and Centre for Perinatal Health Services Research.).

[325] Submission No. 56, p.5 (Association for Improvement in Maternity Services, Qld).

[326] Jordens, Christopher F. C. et al. Use of systematic reviews of randomised trials by Australian neonatologists and obstetricians. Medical Journal of Australia 1998, 168, pp.267-270.

[327] Paterson-Brown S. Are Clinicians Interested in Up to Date Reviews of Effective Care? The British Medical Journal, vol. 307, 4 December 1993, p.1464 and Olufemi A et al. Physicians’ attitude toward evidence based obstetric practice: a questionnaire survey. British Medical Journal, January 31 1998, vol. 316, p.365.

[328] See Committee Hansard 14.9.99, p.414.

[329] Committee Hansard, 14.9.99, p.425 (Health Advisory Committee of NHMRC).

[330] Submission No. 34, p.3 (Division of Women’s Health and Newborn Care - Westmead Hospital).

[331] National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines, Canberra 1999, p.6.

[332] Committee Hansard, 15.9.99, p.533 (Mater Misericordiae Mothers’ Hospital, Qld).

[333] Pelly Janet et al. Clinical practice guidelines before the law: sword or shield? Medical Journal of Australia 1998, 169, pp.330-333.

[334] Tito F, Newby L. Medico-legal implications of clinical practice guidelines. Sydney, National Health and Medical Research Council National Breast Cancer Centre, 1998.

[335] Committee Hansard, 14.9.99, p.417 (Health Advisory Committee of NHMRC).

[336] In Submission No. 14, pp.10-19 (Australian College of Midwives, Vic).

[337] By the Health Services Commissioner, Victoria. See Committee Hansard, 6.9.99, pp.129-130.

[338] Submission No. 5, p.3 (Dr B.R. Pridmore, Queen Elizabeth Hospital, Adelaide).

[339] Figures in this section are from Australian Institute of Health and Welfare. Australia’s mothers and babies 1996, pp.22-26.

[340] Ibid, p.24. These figures exclude data from Victoria, Tasmania and the Northern Territory, which were not available for these comparisons.

[341] Ibid, pp. 25-26.

[342] See Ibid, pp. 24-25.

[343] Submission No. 170, p.8 (Australian Institute of Health and Welfare).

[344] Submission No. 108, p.3 (Professor P Marshall, Flinders Medical Centre).

[345] Submission No. 109, p.16 (NSW Pregnancy and Newborn Services Network and Centre for Perinatal Health Services Research).

[346] Submission No. 34, p.6 (Westmead Hospital).

[347] By the Parliamentary Information and Research Service.

[348] Submission No. 79, p.2 (Women’s Action Alliance (Australia) Inc).

[349] Ibid, p.1.

[350] Committee Hansard, 27.8.99, pp.76-77 (Women’s Hospitals Australia).

[351] Submission No. 111, p.1 (Royal District Nursing Service, Vic).

[352] Submission No. 34, p.6 (Westmead Hospital).

[353] See Submission No. 111, p.3 (Royal District Nursing Service, Vic).

[354] See Submission No. 69, p.27 (Women’s Hospitals Australia & Australian Healthcare Association).

[355] See Submission No. 155, p.6 (King Edward Memorial Hospital, WA).

[356] Submission No. 73, p.3 (Australian College of Midwives, Qld Branch).

[357] See Submission No. 78, p.28 (Mater Misericordiae Mothers’ Hospital, Brisbane).

[358] Committee Hansard, 7.9.99, p.281 (Dr B.R. Pridmore, Queen Elizabeth Hospital, Adelaide).

[359] Submission No. 21, p.4 (Westmead Hospital).

[360] Submission No. 48, p.5 (Australian College of Midwives Inc - Goldfields Sub- Branch).

[361] Submission No. 22, p.3 (New England Area Health Service).

[362] Submission No. 150, p.11 (Royal North Shore Hospital, Sydney).

[363] Submission No. 78, p.25 (Mater Misericordiae Mothers’ Hospital, Brisbane).

[364] Submission No. 16, p.14 (Royal Women’s Hospital Health Service District, Brisbane).

[365] Submission No. 79, p.2 (Women’s Action Alliance (Australia) Inc).

[366] Submission No. 78, p.25 (Mater Misericordiae Mothers’ Hospital, Brisbane).

[367] Submission No. 14, p.13 (Australian College of Midwives Inc, Vic Branch).

[368] Attachment to Submission No. 84 (Birth Matters, South Australia).

[369] Brown, Stephanie and Lumley, Judith. Reasons to Stay, Reasons to Go: Results of an Australian Population-Based Survey, Birth 24: 3 September 1997, pp.148-158. Since this study was conducted post natal length of stay has decreased significantly in Victoria, as in other States.

[370] Ibid, p.154.

[371] Committee Hansard, 14.9.99, p.425 (Health Advisory Committee, NHMRC).

[372] Committee Hansard, 27.8.99, p.76 (Women’s Hospitals Australia).

[373] Committee Hansard, 27.8.99, p.72 (Women’s Hospitals Australia).

[374] Submission No. 69, pp. 27-28 (Women’s Hospitals Australia and Australian Healthcare Association).

[375] Hickey A. R. et al. Early discharge and risk for postnatal depression. Medical Journal of Australia 1997; 167, pp. 244-247.

[376] Submission No. 51, p.10 (Midwifery Practice and Research Centre, NSW).

[377] Submission No. 78, p.26 (Mater Misericordiae Mothers’ Hospital, Brisbane).

[378] This issue is discussed in Submission No. 78, pp.25-27.

[379] Committee Hansard, 15.9.99, p.544 (Mater Misericordiae Mothers’ Hospital, Brisbane).

[380] Submission No. 79, p.1 (Women’s Action Alliance (Australia) Inc)

[381] Submission No. 51, p.10 (Midwifery Practice and Research Centre, NSW)

[382] Attachment to Submission No. 109 (NSW Pregnancy and Newborn Services Network and Centre for Perinatal Health Services Research)

[383] Committee Hansard, 6.9.99, p.108 (Australian College of Midwives Inc, Vic Branch)

[384] Brown, Stephanie and Lumley, Judith. Reasons to Stay, Reasons to Go: Results of an Australian Population- Based Survey, Birth 24: 3 September 1997, pp.155-156

[385] Committee Hansard, 14.9.99, p.439 (Midwifery Practice and Research Centre, Sydney)

[386] Submission No. 51, p.10 (Midwifery Practice and Research Centre, Sydney)

[387] Submission No. 69, p.29 (Women’s Hospitals Australia and Australian Healthcare Association)

[388] Information in this section was provided as an attachment to Submission No. 109 (New South Wales Pregnancy and Newborn Services Network and Centre for Perinatal Health Services Research)

[389] Submission No. 108, p.1 (Professor P Marshall, Flinders Medical Centre).

[390] Committee Hansard, 14.9.99, p.440 (Midwifery Practice and Research Centre, NSW).

[391] Submission No. 108, p.1 (Professor P Marshall, Flinders Medical Centre).

[392] Submission No. 51, p.2 (Midwifery Practice and Research Centre, NSW).

[393] Committee Hansard, 7.9.99, pp.186-187 (Professor P Marshall, Flinders Medical Centre).

[394] Submission No. 108, p.1 (Professor P Marshall, Flinders Medical Centre).

[395] Committee Hansard, 7.9.99, p.250 (Department of Human Services, Vic).

[396] Committee Hansard, 27.8.99, p.81 (Australian Health Insurance Association Ltd).

[397] King, James E. Obstetric intervention and the economic imperative, British Journal of Obstetrics and Gynaecology, April 1993, Vol. 100, p.303.

[398] Committee Hansard, 6.9.99, p.171 (National Association of Specialist Obstetricians and Gynaecologists).

[399] Committee Hansard, 6.9.99, pp.98-99 (Dr Jane Fisher, University of Melbourne).

[400] Committee Hansard, 14.9.99, p.461 (NSW Pregnancy and Newborn Services Network).

[401] Committee Hansard, 15.9.99, p.513 (Professor James King, Qld Council on Obstetrical & Paediatric Morbidity and Mortality).

[402] Submission No. 14, p.5 (Australian College of Midwives Inc, Vic Branch).

[403] All figures in this section are from Health Insurance Commission Medicare Benefits Schedule Item statistics generated 5 October 1999 (excluding services provided by hospital doctors to public patients in public hospitals).

[404] See Senate Community Affairs Legislation Committee, Committee Hansard, estimates 31.5.99, p.102.

[405] Submission No. 146, p.3 (Australian Health Insurance Association Ltd).

[406] Submission No. 175, p.7 (Australian Medical Association Ltd).

[407] Submission No. 89, p.12 (Catholic Health Australia).

[408] Submission No. 100, p.1 (National Association of Specialist Obstetricians and Gynaecologists).

[409] See Senate Community Affairs Legislation Committee, Committee Hansard, estimates, 31.5.99, pp.102-103.

[410] Additional information to Senate Community Affairs Legislation Committee estimates, 31.5.99.

[411] Submission No. 70, p.7 (Royal Australian College of General Practitioners).

[412] Submission No. 51, p.13 (Midwifery Practice and Research Centre, NSW).

[413] Committee Hansard, 6.9.99, p.98 (Dr Jane Fisher, University of Melbourne).

[414] Submission No. 153, pp.15-16 (Maternity Alliance, NSW).

[415] Submission No. 109, p.21 (NSW Pregnancy and Newborn Services Network and Centre for Perinatal Health Services Research).

[416] Supplementary information, 7.9.99 (Royal Women’s Hospital, Vic).

[417] Submission No. 78, p.37 (Mater Misericordiae Mothers’ Hospital, Brisbane).

[418] Supplementary information, 7.9.99 (Royal Women’s Hospital, Vic).

[419] Submission No. 46, p.10 (Royal Women’s Hospital, Vic).

[420] Review of Professional Indemnity Arrangements for Health Care Professionals. Compensation and Professional Indemnity in Health Care - A Final Report. (PIR Final Report) AGPS Canberra November 1995 (Australian Government Publishing Service) AGPS Canberra : chapter 10. Copies of this chapter and the rest of the report are available at the following location on the Department of Health and Aged Care’s web-site: http://www.health.gov.au/pubs/hrom/theainsu2.htm.

[421] Parliament of Victoria Law Reform Committee. Legal liability of health service providers. Final Report. (VLRC Report) May 1997 Victorian Government Printer Melbourne.

[422] See VLRC Report at note 2 : p.xvii.

[423] See PIR Final Report - note 1: para 2.93, p.31.

[424] Tito F. “Royal Australasian College of Surgeons Workshop on Medical Litigation - Alternative Processes - Friday 30 October 1998: Summary of Proceedings” in The Quarterly Journal of the Royal Australasian College of Medical Administrators March 1999 vol 32(1): p.6.

[425] Ibid, p 5.

[426] Statements made by Dr Phillip Cocks of the National Association of Specialist Obstetricians and Gynaecologists at the joint RACOG/NASOG conference entitled ‘In the Trenches’ held in Sydney on 24-25 April 1999.

[427] The PIR reported that ‘This data on claims made between 1980 and 1993 was kindly provided by the Medical Protection Society - other MDOs were unable or unwilling to provide this information, though none have provided any contrary information to this. The view has been conveyed by several that this is broadly similar to their experiences’. It is understood that the perception is that the pattern remains similar in more recent years.

[428] PIR Final Report - see note 1: paras 10.52-10.53, p.275.

[429] Some examples where MDOs have exercised their discretion against a doctor or class of doctors has been the retrospective exercise of the discretion after Dr Harry Bailey's death by suicide in relation to claims arising from his activities at Chelmsford by the NSW Medical Defence Union, and the refusal by the Medical Protection Society to pay claims incurred but not reported at the date of cessation of membership for past members who transferred to the Medical Defence Association of Victoria or the Medical Defence Association of Western Australia.

[430] Public statements by Dr Megan Keaney, United Medical Defence.

[431] PIR Final Report - see note 1, para 9.5, pp.225-226.

[432] PIR Final Report - see note 1 : paras 9.8-9.11, p.226.

[433] PIR Final Report - see note 1: recommendation 137, para 9.90, p.239; and recommendation 136, para 9.80, p.237.

[434] Review of Professional Indemnity Arrangements for Health Care Professionals. Compensation and Professional Indemnity in Health Care - An Interim Report. (PIR Final Report) February 1994 AGPS Canberra: para 6.86, p.162.

[435] PIR Final Report - see note 1: para 9.179, p.255. Also see more generally paras 9.178-9.187, p.255-256.

[436] MIPS. Back Funding Contribution Fact Sheet, November 1999: p.1.

[437] MIPS. Back Funding Contribution Fact Sheet, November 1999 : p.2.

[438] VLRC Report - see note 2 : p.xviii

[439] VLRC Report - see note 2 : para 9.68, p.230.

[440] PIR Final Report - see note 1: para 2.63. p.26.

[441] Nisselle P. Murray J. ‘Obstetrics in crisis?’ 1993 Medical Journal of Australia, vol 159, pp.219-221: 219.

[442] PIR Final Report - see note 1: paras 10.62-10.64, p.278.

[443] For information on the Victorian Government’s special arrangements, see VLRC Report, paras 9.63-9.68, pp.228-230.