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MIDWIVES will not flee the state’s chronically understaffed public hospitals, despite budget moves to allow them to set up private practices from the end of next year, the Australian College of Midwives said.
The Federal Government’s overhaul of maternity services will allow some of the nation’s 12,000 midwives to prescribe drugs subsidised by the Pharmaceutical Benefits Scheme and claim Medicare rebates for managing pregnancies, deliveries and postnatal care.
Independent midwives will also be granted indemnity insurance and visiting rights to hospitals, despite opposition from doctors’ groups.
… “[These changes] potentially meet the needs of the majority of women … from the middle of our largest cities to remote communities. It is not about midwives being independent of the system. We have always worked with doctors and we always will. It is the safest and best way, but these changes will make it more financially viable for everyone.”
But obstetricians are concerned that public and private hospitals could be stripped of experienced midwives, putting women at risk. “They are saying that won’t happen but we just don’t know yet,” the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Dr Ted Weaver, said yesterday.
“There is every chance some of these models of care being examined will be very attractive to midwives and entice them away from their traditional places of employment, such as hospitals.”
Ahem, what does that say about hospital employment, if this doctor fears that midwives will all leave if oddered an alternative way to practice?
Professor Dahlen said the changes would attract more midwives and retain those already in the system because they would be able to practise to the full scope of their abilities “rather than be frustrated by a medically-dominated model of care”. She said that not all midwives would want to manage their own businesses.
Dr. Andrew Pesce … said if the Government underwrote midwives’ indemnity insurance that could disadvantage GPs who also deliver babies.
Under a current scheme, the Government already subsidises GP obstetricians’ insurance premiums if these amount to more than 7.5 per cent of their fees for providing the service. Unless access to subsidised insurance was offered equally to both groups, doctors might be put at a “competitive disadvantage [compared to] midwives”, Dr Pesce said.
The Rural Doctors Association of Australia welcomed the changes, saying it would free GPs in regional areas.
Interesting that the issue of competitive advantage comes into play. Hannah Dahlen makes a great point that not all midwives will want to leave the hospital system. I agree totally! being self-employed and managing a business is, in many ways, much harder and more demanding (also more rewarding) than working in a hospital where a stable and dependable amount of money appears in one’s bank account every 2 weeks.
Melissa Maimann, Essential Birth Consulting 0400 418 448
I was just wondering about a pertinent aspect of the midwifery model of care that women receive in the hospital; the aspect of the training and knowledge of the midwife about hospital and state policy, guidelines, and law. If (advanced practice?) midwives are given the chance to practice privately in hospital, subject to collaboration, adherence to guidelines and mandatory reporting of deviance, can women expect that doctors who choose to practice without valid consent will be reported to the hospital and respective Commission?
And what about midwives who are employed by the hospital, who are more likely to experience obstetric intervention with their patients? Will they be more likely to come forward when consent has not been legally obtained?
Also, what is your view on Cytotec for VBAC? The ACOG in the US has banned it’s use for VBAC, but there appears to be no guideline here.
Hi Marge,
re: your first comment, I thought exactly the same thing – that mandatory reporting will make doctors and midwives more accountable for the care they provide. They will have to seek and obtain informed consent, and procedures / operations that are performed for invalid reasons and without the agreement of the patient can be reported. We’ve always been able to report such issues (and face the consequences), but now the law will mandate it (hopefully with whistleblower protection). I do wonder if it will create an \us and them\ is private midwives and hospital-employed midwives are working together in hospitals.
I can see many midwives leaving to go to private practice – here in Sydney this is already happening and the changes haven’t even come into effect. However I think the majority of midwives will remain hospital empoyees. The average age of a midwife is maybe 45 or 50, and most midwives are part time to fit in with their families. That sort of midwife will not leave the financial security of hospital to work on a continutiy of care model where they may be called at any time of the day or night.
Re: your second comment, Cytotec is not used here in Australia for VBACs. It is used in some hospitals for the mgmt of PPH, but induction of VBAC is not promoted. If VBACs are induced, the hospital usually uses a foley’s catheter and maybe an AROM and a small dose of syntocinon (pitocin) – but this is not commonly used for fear of rupture. Cytotec is definitely not used!
I believe there were some studies that you may be aware of from the US pointing to higher rates of rupture from Cytotec.