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Slow progress on ‘landmark’ maternity reforms

Major stumbling blocks still exist for eligible midwives and nurse practitioners to take advantage of the government’s reforms. Linda Belardi reports.

Fewer than five eligible midwives have managed to sign a collaborative agreement with a doctor, one year into the federal government’s ‘‘landmark’’ maternity reforms. A collaborative agreement is required for private midwives to be able to deliver Medicare-funded midwifery services granted to them in November 2010.

From a total workforce of 42,000, there are currently 97 eligible midwives across the country but over half are concentrated in Queensland and predominantly in metropolitan areas. In the last 12 months, eligible midwives have delivered over 5,200 taxpayer funded maternity services to women.

Hannah Dahlen, spokeswoman from the Australian College of Midwives, said the limited number of collaborative agreements with obstetricians was proving to be a major stumbling block. While many doctors were supportive of informal collaboration, she said they were wary of a signed document due to an increase in liability.

“The reality is that collaboration is not occurring in great enough numbers for this to be something that meets the needs of women.

“There are many midwives who are interested in taking up these reforms, but they are waiting until it becomes a viable option for them. Midwives are waiting for visiting rights to be made available in hospitals so they can deliver continuity care and for the easing of the requirements for collaborative arrangements which present a significant roadblock.”

Clinical privileging arrangements would grant hospital access for private midwives allowing them to deliver intrapartum care, as part of a continuity model of midwifery services.

“Currently if we transfer a woman into hospital or she wants to give birth in hospital – we are relegated to acting as a support person. It’s really an insult to midwives that they can’t go into hospital with their clients and provide care as professional midwives.”

Marie Heath, president of the Australian Private Midwives Association, said the uptake for Medicare eligibility by midwives had not been as significant or broad-ranging as hoped. She said until eligible midwives began working in rural and regional Australia, the reforms would fail to target women most in need.

Heath said there was also a lack of support for midwives to transition into private practice. An application for funding from Midwives Australia to roll out a mentoring program nationally has been rejected by the Department of Health and Ageing, she said.

“I don’t know why the federal government would set up a 124 million maternity services reform package and not acknowledge that there is some need to support those midwives to transition across to private practice and into the eligible midwife status. “

She said there has been no significant direction or leadership from the federal minister or the Department of Health and Ageing to encourage the state health ministers to look at visiting access for midwives.

As part of its lobbying activities only Queensland and ACT health ministers have agreed to meet with the Australian Private Midwives Association to discuss the reforms which Heath says indicates a lack of political engagement from the majority of health ministries.

In August, Australian Private Midwives Association and Midwives Australia wrote to all private hospitals in the country to discuss the process of extending visiting rights for midwives into private hospitals. Not one hospital indicated they wanted to begin dialogue on this potential arrangement.

There is also yet to be an acknowledged course accepted through AHPRA to allow private midwives to begin utilising their prescribing roles.

“The potential and opportunity of the reforms won’t be realised until we alter the way it is being implemented and supported both in clinical and professional manners,” said Heath.

Meanwhile, there has been some fallout regarding the impact of MBS and PBS rights for nurse practitioners. Louise Stewart, founder and CEO of Revive Clinics, which provides nurse practitioners to community pharmacies, says the current Medicare rate is too low for private nurse practitioners to make a living.

“It’s a start. I don’t think that we have got anywhere near as far for what’s required to actually make this role viable in many primary care environments.”

She said the collaborative arrangements for nurse practitioners and midwives were are anti-competitive.

“There is an attitude that [the] nurse practitioner is competition which is not correct. They do offer a different type of service then going to your doctor.

Nurse practitioners are able to fill that gap and with the current workforce there is a probably an incredibly small percentage that are working as nurse practitioners which is disappointing.”

She said the collaborative agreements were contradictory to the nurse practitioner acting as an autonomous professional and should be reviewed.

“The requirement for a collaborative arrangement was purely and simply to appease the AMA and doctors groups. It’s political and it’s creating a massive barrier for this initiative to be successful.”

Stewart said she was still shocked by the level of resistance from some individual GPs to having a nurse practitioner in primary care and opposition had forced the closure of one Revive Clinic in WA.

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