title: 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.
  
  
  OBJECTIVE
  a critical analysis was undertaken for the purpose of identifying discourses that have influenced the direction of the Australian maternity care reform agenda.
  
  
  METHODS
  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.
  
  
  RESULTS
  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'.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston 3199, Australia. Meredith.McIntyre@monash.edu.au
authors.forename: Meredith
authors.initials: M
authors.lastname: McIntyre
authors.forename: Karen
authors.initials: K
authors.lastname: Francis
authors.forename: Ysanne
authors.initials: Y
authors.lastname: Chapman
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D016550:Birthing Centers / Q000458:organization & administration*; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D008427:Maternal Health Services / Q000458:organization & administration*; D008429:Maternal Welfare; D008880:Midwifery / Q000458:organization & administration; D009313:National Health Programs / Q000458:organization & administration*; D061214:Patient Safety; D011247:Pregnancy; D011785:Quality Assurance, Health Care / Q000458:organization & administration*