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Private midwife, public hospital

In a first for Australian health, private-practice midwives are being given access to the birthing and postnatal services of hospitals.

Nurses and midwives now have the opportunity to work in self-employed mode within the health service.

“It opens up a whole new world of opportunity for women, regardless of their circumstances,” said Liz Wilkes, president of Midwives Australia.

Continuity of care is the principle behind the move, with research suggesting it’s what Australian women want.

“Women, regardless of what happens in their pregnancy, will get full continuity of care the whole way through,” said Wilkes. “In other models, if something complex happens they forgo midwifery care and just have the obstetric care. In this case they can have both – the team will work collaboratively.”

On October 1, Gold Coast Hospital and Health Service led the way by implementing an Access Licence Agreement that provides visitation rights for midwives in private practice.

According to project manager Anne Moore, assistant director of nursing, midwifery, there were several drivers to the change.

“In 2010, legislation was passed by the Commonwealth enabling eligible midwives to apply for a Medicare provider number,” she said.

“A notation as an eligible midwife with the Australian Health Practitioner Regulation Agency demonstrates the midwife is competent across the full scope of midwifery practice: antenatal, births and postnatal care. The government further provides indemnity insurance.”

As part of the determination in 2010, midwives had to demonstrate collaboration by either signing an agreement with a medical officer or communicating verbal and written care plans with other providers, including GPs, obstetricians and hospitals.

“In 2011, the Queensland government and the Nursing and Midwifery [Board of Australia] office in Queensland supported a state project to look at providing access for midwives,” Moore explained.

The project became very challenging around the collaborative element – and the hospitals team could not see it working in the Gold Coast District.

With this in mind, the Access Licence Agreement was developed, which included guidelines and work instructions to demonstrate the collaboration without the collaborative agreement.

“Women are booked here as private patients [of the midwife], and if all is well, then the midwife will be the maternity lead carer for the women for antenatal, birth and postnatal care for up to six weeks,” said Moore. “If it becomes complex in any way, then the lead carer may be one of our obstetricians and the midwife will provide midwifery care.”

According to Moore, the federal government is going to change the legislation enabling midwives to work without a signed agreement with a medical officer: “It actually validates what we have developed.”

Gold Coast Hospital and Health Service has now credentialed four midwives to work under this new framework, with each allowed to look after 40-50 women a year. The first birth occurred in mid-October, with mum and baby leaving the hospital four hours after birth, to be supported by midwife at home.

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