A big political win for midwives

The hunt is still on to find insurance for homebirth services but a two-year extension on indemnity will give some breathing room, writes Hannah Dahlen

The Standing Council on Health (SCoH) has recommended an extension of the professional indemnity insurance exemption for privately practising midwives until June 2015.

This enables midwives providing homebirth services to have assurance that they will not be forced to abandon women or face prosecution for violating registration requirements.

There has been no insurance for homebirth since 2001 following the collapse of HIH and withdrawal of the only product available for midwives. With the change to National Registration it became compulsory to have insurance.

The extension of the exemption for private midwives to have insurance for homebirth from the original date of June 30, 2013, to June 30, 2015, means that homebirth will not become essentially an illegal activity for midwives in the near future.

All efforts must be expended now to seek an insurance product, as it is not acceptable that this choice, one supported by evidence as having significant benefits for women when undertaken in an appropriate safety and quality framework, remains uninsured. Both women and midwives deserve to have the protection insurance brings.

At the same SCoH meeting on August 10, the Commonwealth also agreed to vary the Determination, a piece of legislation implemented in 2010 stipulating that private midwives needed to have signed agreements or referrals from doctors. The changes would mean these collaborative agreements could now be between midwives and hospitals and health services, moving away from the emphasis on the named medical practitioner.

For me it was a time of reflection as I had been the Australian College of Midwives (ACM) president two years ago when on September 20, 2010, ACM along with the ANF and CRANAplus met with the minister, Nicola Roxon’s, office and asked that the words “named medical practitioner” and “acknowledged by a named medical practitioner” be removed from the legislation and replaced with a “health provider organisation”, which would cover both hospitals and Aboriginal Health Services.

Roxon’s office made very clear to us this was not negotiable and we risked losing the reforms for midwives altogether. We were promised changes, however, if the legislation proved to be unworkable.

The reforms for midwives came in on November 1, 2010, and midwives spent the next two years trying to make the Determination work, with the requirements for collaboration with medical practitioners sneaking their way into insurance requirements and clinical privileging.

Some midwives virtually lobbied every obstetrician in their state to sign a collaborative arrangement but to no avail. Yes, there have been some successful collaborative arrangements with obstetricians, which we must celebrate and continue to embrace when they are achievable, but on the whole with less than 150 midwives taking up Eligibility in two years and less than 100 of these claiming Medicare and a tiny number of these claims being for birth care, we have demonstrated the arrangements, as we strongly argued in 2010, won’t work.

Changing the Determination to enable collaborative arrangements between midwives, hospitals and health services will hopefully now enable states and territories to implement clinical privileging that is not solely dependent on a collaborative agreement with a named medical practitioner.

It does not solve the problems associated with private patient status and who provides emergency medical care if required, but it opens the door for health services to try new and innovative solutions when trying to function within the boundaries of a funding system that is essentially designed for doctors and hence a very bad fit for midwives.

Most significantly for me this change in legislation is symbolic for midwives. It was against all the principles of true collaboration and midwifery autonomy to make one professional group dependent upon another competing professional group. Women were the biggest losers, because we must not forget the requirement for a collaborative arrangement was around Medicare rebates for midwifery services, not about midwives being able to practice.

In America it took over a decade of intense political battles to start the roll back on collaborative arrangements with obstetricians and in Australia it only took two years. It felt like a long two years but it was worth the persistence and ACM was at the forefront of this battle along with the consumers who always make us more powerful. The ACM congratulates the Federal Minister for Health, Tanya Plibersek, for this historic decision.

Dr Hannah Dahlen is associate professor of midwifery at the University of Western Sydney. She is the national media spokeswoman for the Australian College of Midwives and past president.

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