The Health Minister has moved to close a legal loophole that allows unregistered midwives and doulas to deliver babies. This has caused an outcry as it is seen to remove choice from women with regard to whom they have present at their birth.
How did this come about? We have always had lay midwives, doulas and other non-regulated people attending women at home for birth whether high risk or low risk. In 2010, insurance became mandatory for midwives and with insurance came a few strings. Also, the ACM guidelines which specify which women can remain under midwifery care without obstetric input, and which women will need obstetric input, were formalised into codes and guidelines used by our registering authority (as well as the insurance company) to provide structure and guidance around the boundary between midwifery and obstetric care. As well as this, a whole raft of guidelines, position statements, codes and laws came into effect. At the time, I remember feeling overwhelmed by it all: it seemed that each time I had a look at the Board’s website, there was a new code, guideline or position statement to assimilate into my practice.
A registered midwife needed to comply with all of these codes, guidelines, position statements and laws. Alternatively, we could surrender our registration and keep on keeping on. No insurance, no guidelines, no regulations, no laws. Nothing. With much lower overheads (no requirement for continuing professional development, insurance, peer review, college membership etc), unregistered midwives could offer their services more cheaply and more importantly, without all the restrictions that went with a registered midwife’s practice.
A recent coronial inquiry into homebirths that were attended by an unregistered midwife has made several recommendations, and one of these was to criminalise the practice of midwifery by people who are not registered midwives or doctors. The catalyst for this move has been the actions of one individual, unregistered midwife. Homebirth groups are appalled at the restriction of choice, while failing to appreciate that one person’s actions has led to this restriction of choice. I wonder, if lay midwifery / doula work been regulated from within and produced outcomes that were favourable when compared with national data, would there be a need for this external regulation? In failing to be accountable to a profession, lay midwives, doulas and unregistered midwives are now forced to cease all practice.