AMA President, Dr Rosanna Capolingua, said the AMA recognises that women like to have options and choice in relation to maternity services but it was critical that those options were safe and medically supervised.

If and when women choose to access antenatal care and delivery without access to medical supervision and back up, then they must be fully informed about what that choice means to them and their babies.

"We're pleased to see that the Federal Government's Maternity Services discussion paper released today already recognises that 'unless such services can be developed in collaboration with GPs and obstetricians, there are potential safety risks'," she said. The paper states that "today Australia is one of the safest in the countries in the world in which to give birth or be born."

"Australia has seen a 35 per cent decrease in perinatal deaths over the past 35 years as a result of the excellent maternity care provided in this country under medical supervision.

"It is important that these good health outcomes are not compromised as a result of any changes to maternity services in Australia."

Dr Capolingua said midwifery services operating independently and away from comprehensive medical care actually remove patient choice in complex or emergency situations.

"Women in these situations may not be able to get access to specialist obstetric, anaesthetic and paediatric care that they and their baby require.

"Many previous surveys have confirmed that women want to deliver at a location where they have access to a doctor. This makes them feel safe and secure in what are often unpredictable circumstances."

Dr Capolingua said it was also essential that a doctor was available to examine a baby at birth and that midwives had access to comprehensive medical services if a mother or baby needed them.

"There is a particularly high risk of establishing independent midwifery units in rural and remote areas where there is even less access to medical care. Transfer times for our rural mums and bubs in trouble at delivery puts them at even greater risk than women in metropolitan areas."

"Rural Australia needs support back into its local hospitals so that midwives and doctors working together providing peri natal care have the facilities their patients need."

The AMA said the ideal model for maternity services was a team-based approach which was women-centred, well co-ordinated and based on mutual respect and collaboration between obstetricians, GPs, nurses and midwives.

"Medical competencies and the skills of nurses and midwives should all be used appropriately in the interests of patient safety and high-quality family support. These arrangements should ensure that transfer of care in an emergency situation is as safe as possible."

Dr Capolingua said the Government's review provided a number of opportunities to enhance comprehensive patient care while ensuring that consolidation rather than fragmentation in maternity services was the goal.

"Any changes to the way care is currently delivered to pregnant women and their families must ensure that a high standard of care is maintained and that quality of care is not compromised. Women need to understand that studies have shown that their babies are three times more likely to die in a home birth compared to a birth in hospital.

"Future arrangements for maternity services in Australia should ensure that women are well informed about various options and their commensurate risks, particularly in relation to their own medical circumstances."

Dr Capolingua warned that progressing down the 'New Zealand path' - babies are not seen by doctor for sometimes 18 months after the birth - was not the way we wanted to go in Australia.

The AMA looked forward to being actively involved in the consultation and discussion process for the Maternity Services Review.

Italian and U.S. biologists this week report that a little-understood protein previously implicated in a rare genetic disorder plays an unexpected and critical role in building and maintaining healthy cells. Even more surprising, their report in the journal Nature shows that the protein, called "atlastin," does its work by fusing intracellular membranes in a previously undocumented way. "If you'd asked me a year ago whether this was possible, I would have said, 'No,'" said study co-author James McNew, associate professor of biochemistry and cell biology at Rice University. "In fact, that's exactly what I told (co-author) Andrea Daga when we first spoke about the idea a year ago." McNew has spent the past 15 years studying SNARE proteins, a specialized family of proteins that carries out membrane fusion. It's a vital process that happens thousands of times a second in every cell of our bodies. "It is fitting that the discovery of a new protein capable of fusing membranes comes 10 years after the demonstration that SNAREs can fuse lipid bilayers," said Daga, a researcher at the Eugenio Medea Scientific Institute in Conegliano, Italy. In the new study, Daga's and McNew's research teams used fruit flies to study how atlastin functions. The atlastin in fruit flies is very similar to the human version of the protein and serves the same function. "Prior to this, there were only two defined ways in which you could take biological membranes and put them together in a specific way," said McNew, a faculty investigator at Rice's BioScience Resesarch Collaborative. "Atlastin is the third, and it's the only one that requires enzymatic activity, so it's distinctly different." Using a range of tests on purified proteins, live fruit flies and cell cultures, the Italian and U.S. teams examined the effect of both an overabundance and a scarcity of atlastin on cell function and on fruit fly development. They also created mutant versions of the protein to see how it functioned -- or failed to function -- when some parts were disabled. The tests showed that cells with extra atlastin had an overdeveloped endoplasmic reticulum (ER), a system of interconnected membrane tubes and chambers that's critical for normal cell function. The tests also showed too little atlastin led to a fragmented ER. Flies with defective atlastin were sterile and short-lived. "The endoplasmic reticulum is an ever-changing environment," McNew said. "It grows. It retracts. It expands. It collapses. It's highly dynamic, and for that to be the case, there has to be a mechanism by which it can grow new pieces and connect those pieces together. That's where the fusion comes in." Daga said the discovery will lay the foundation for a deeper understanding of both basic biological processes and disease. "We hope the findings lead to a better understanding of hereditary spastic paraplegia (HSP), the genetic disorder that atlastin has been linked with," Daga said. HSP is a rare genetic condition that affects fewer than one million people worldwide. It's marked by a partial paralysis of the lower extremities due to defects in the body's longest cells, the neurons that run from the spine through the legs. Daga said atlastin's role in building and maintaining a healthy ER may help HSP researchers better understand why neurons are affected first. "This is the first clue," Daga said. "We have the definition of what the protein does. Now we need to explore how it does that, and what it means." Co-authors include Genny Orso, Diana Pendin, Jessica Tosetto and Andrea Martinuzzi, all of Eugenio Medea Scientific Institute; Song Liu, Tyler Moss and Joseph Faust, all of Rice; Anastasia Egorova of Consorzio Mario Negri Sud in Santa Maria Imbaro, Italy; and Massimo Micaroni, now of the University of Queensland in Brisbane, Australia, Drugstore Alismed. The research was supported by the National Institutes of Health, the G. Harold and Leila Mathers Charitable Foundation, Telethon Italy, the Italian Ministry of Health and the Foundation Compagnia di San Paolo