Posted by Melissa Maimann on Jul 31, 2010 in
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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MIDWIVES are aggrieved about new rules that might curb their access to Medicare rebates and prescribing rights …
Last year Ms Roxon announced that from November this year midwives would for the first time be able to use the Pharmaceutical Benefits Scheme and Medicare rebates for their clients.
At the time, Ms Roxon said the historic move would boost a midwife’s ability to work independently and increase options for pregnant women …
But in a long-awaited change to the legislation … midwives will now have to work collaboratively with a doctor, who must endorse their practice before their clients can access financial benefits.
The requirement for collaboration was always planned to be in place, but the detail of collaboration requires that a midwife has a written agreement with an obstetrician to access medicare benefits. This is problematic: more than one obstetrician must sign an agreement because no obstetrician provides 24/7 cover, so there’d need to be at least 2 obstetricians signing the agreement. What happens if one obstetrician leaves the local area? Is sick? Goes on leave? In these situations, the collaborative agreement is very vulnerable. Not only the agreement, but the midwife’s ability to provide ongoing care to her private clients.
After eight months of debate between doctors and midwives, government records show that Ms Roxon signed a determination on the matter two weeks ago, when Parliament was out of session.
Doctors’ groups who say home birth is unsafe are believed to have lobbied the government for the changes.
Yesterday, midwives and home-birth advocates accused Ms Roxon of trying to hide what will be an unpopular decision with midwives and mothers.
Australian College of Midwives president Hannah Dahlen said the change would effectively give doctors the ability to veto their access to Medicare and the PBS.
While midwives working inside hospitals would not be disadvantaged, she said private midwives would find it difficult to find a doctor to endorse them, especially if the doctor did not support home birth.
In fact, doctors have refused to sign agreements with any midwife who attends homebirths. Is this collaboration or control?
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, Maternity Services Review, midwife, Midwifery, Obstetrics
Posted by Melissa Maimann on Jul 30, 2010 in
Birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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The AMA welcomes the Government’s introduction of new regulations that require midwives … to collaborate with medical practitioners in order to provide Medicare-funded services to patients or prescribe them medications under the Pharmaceutical Benefits Scheme (PBS).
AMA President, Dr Andrew Pesce, said today that the new arrangements would provide a safer higher standard of care for patients.
… “There is now a requirement for midwives … to establish collaborative arrangements with a medical practitioner in order for the service to attract a Medicare patient rebate or PBS benefit.
And that’s the problem: midwives are required to establish collaborative agreements, but obstetricians do not have to collaborate with the midwife. And there are fears that if the midwife does not work according to the obstetrician’s protocols, the agreement will be revoked. this does nothing to establish midwifery as a profession in its on right.
… “Evidence shows that patients enjoy better health outcomes when they receive coordinated, continuous, and comprehensive care that is delivered by appropriately trained health professionals,” Dr Pesce said.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Maternity Services Review, midwife, Midwifery services, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jul 19, 2010 in
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
The Government’s $120 million national Maternity Reform Package is currently being implemented. There is still much work to do. From 1 November 2010, women will be able to claim Medicare benefits from care that is provided by eligible midwives. Women will need to ensure that their midwife is eligible, prior to engaging her services, if she wishes to claim medicare benefits.
It is still not known how much women will be able to claim through medicare and these details will not be known until closer to November 1, 2010.
Midwives have been lobbying hard around the one key sticking point of these reforms: how midwives and obstetricians will work together in defined collaborative agreements. The Maternity Services Review recommended that medicare be extended to midwives who work in collaborative agreements with obstetricians, however the definition of collaboration has only just been revealed.
The definition of a collaborative arrangement provides for four options, each requiring signed agreement from the obstetrician. No collaborative agreement = no medicare benefits for the woman.
One option is a contract of employment whereby the midwife is employed by the obstetrician. Personally, I would have suggested that this go the other way around: considering that most women have healthy pregnancies and do not require the services of an obstetrician, the midwife ought to employ the obstetrician on a sessional basis for her private clients when obstetric services are required.
Option two requires that the obstetrician refers a woman to a midwife for midwifery care. I truly cannot see this option working in the private health system. What incentive is there for the obstetrician to refer his/her patients to a midwife?
Option three requires a signed collaborative agreement between the midwife and obstetrician. But there’s a catch: no obstetrician is on call for 24/7/365. Hence, at least two obstetricians will need to sign this agreement for it to be in force 24/7/365. What should happen when one partner wishes to pull out, goes on leave, has a holiday and so on? This suddenly leaves the midwife – and all of her private clients – without an agreement, without medicare and without care.
Option four requires oodles of paperwork on the midwife’s part. I don’t mean to be negative but it would work out to be: spend one hour with the woman and one hour chasing the paperwork. Yes, there’s a *lot* of paperwork. And every time a piece of paper is forwarded to the obstetrician, the obstetrician must acknowledge receipt of this. There are at least seven points in the pregnancy where a midwife will need to photocopy and fax / post; or scan and email documents to the obstetrician and then document that the obstetrician has acknowledged receipt of these documents. A nightmare for all!!
So where are we going with all of this and what is the big picture? The big picture as I see it, is that sometime towards the end of the year, eligible midwives will have visiting / admitting rights at hospitals. Their clients will be able to claim medicare benefits for their services for the very first time, bringing down the cost of private midwifery care significantly. Women will be able to book with their private midwife of their choice, and also be admitted to hospital for birth under the care of their chosen private midwife, presumably as a private patient. If obstetric care is needed, the midwife would have ready access to a named obstetrician who could assist the woman, enhancing continuity of care to the woman. This system would provide true continuity of midwifery and obstetric care to women.
However, we have a long way to go. The collaborative agreements, as they stand, require an obstetrician’s sign off before the midwife can provide medicare-rebatable services to women. Some obstetricians, it seems, are very supportive of an employment model whereby the midwife is an employee of the obstetrician, however for the midwife who has her own successful and thriving business, this option will not be satisfactory. Much work needs to be done to explore models of care, facilitate visiting rights for midwives and protect the right of the midwife to practice as an autonomous practitioner, a specialist in natural birth.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Maternity Services Review, Midwifery, Midwifery services
Posted by Melissa Maimann on Jul 11, 2010 in
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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I am a midwife who wants to continue to provide private midwifery care. The systems and protection mechanisms that came into effect on July 1 are letting down midwives and women …
The experienced midwife has watched the deteriorating standards of care in hospitals. Consumers and midwives asked the politicians and the various health authorities for change, but what have we ended up with? A confusing set of rules that reduce women’s birthing choices and rights to privacy.
I have read the two professional indemnity insurance policies available for private midwives … I now have to scratch a plan of care that by virtue is demonstrating the “collaboration of care”, or signing over a woman’s right to privacy to a doctor or a hospital.
As for collaboration, the definition of this term cannot be agreed by legislators, health professionals or bureaucrats. I will pay a minimum of $5000 for the four to five private clients a year. Since July 1, if I do not have profession indemnity I will not be meeting the professional standards of the new national Nurses Midwives Registration Board, and I could be disciplined, de-registered or fined.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Maternity Services Review, midwife, Midwifery, Midwifery services
Posted by Melissa Maimann on Jun 29, 2010 in
Birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
I am often asked what the difference is between the private and public options for pregnancy and birth.
Both options enable women to access midwifery care or obstetric care and both options enable women to birth at home or in hospital. So you might be wondering what the difference is for the woman going through each system.
Private care generally affords women:
- Choice of care provider
- Choice of place of birth – home, hospital, public or private hospitals
- Greater comfort and a more personalised service
Public care options often mean:
- a midwife or obstetrician will be assigned to you; you will not be able to choose your care provider
- Choice of place of birth is limited. Homebirth is only an option at a minority of hospitals and women generally have to go to the pubic hospital that is closest to their home
- Services cater more to the immediate physical needs with little appreciation for the emotional and mental journey of pregnancy and birth.
- Services are standardised by hospital policies. The same policies will apply to all women birthing at that hospital with little scope for movement.
The good news about private midwifery services is that after November 1 this year, families will be able to claim Medicare benefits for the care that is received from a private midwife. This rebate will significantly bring down the prices for private midwifery care, making it an affordable option for women wanting to birth in hospital with a private midwife, or at home.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Maternity Services Review, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Jun 28, 2010 in
Home birth Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
I was sad to read this article in the papers yesterday (although I love the beautiful homebirth photo that it included!)
The article is entitled, “Homebirth Laws Confusion” and only served to increase the confusion about homebirth.
Homebirth is not illegal. Nor will it be after July 1 this year.
MIDWIVES attending home births in Tasmania could be liable for misconduct prosecution after July 1.
The article stated that, “Australian Nursing Federation state secretary Neroli Ellis said the changes meant midwives who continued attending home births could be open to misconduct liability legal action.”
The reported interviewed a well-known and experienced midwife who was quoted as saying, “The new regulations are meant to take effect from July 1 but there is nothing in place and we have no idea what we are meant to do” … She said she suspected the regulations were a backdoor way of banning home births.
The ANF is only correct *if* the midwife practices homebirth without insurance. So long as the midwife has insurance for pregnancy and postnatal care, it is perfectly legal for midwives to continue to attend births.
There may be some issues with insurance:
- The policy is quite expensive, especially for midwives with low caseloads, and costs for homebrith are expected to increase
- The insurance policy requires that the woman books into a hospital and that the midwife shares with the hospital a maternity care plan for the woman – in the interests of safety
- The insurance policy demands that the midwife works to evidence-based guidelines and best practice.
But … so long as these conditions are met, homebirth is, and remains, perfectly legal.
Women having homebirths need to know that there is no insurance for the actual birth. Pregnancy and postnatal care is covered by insurance. You can expect to sign a form stating that your midwife has told you about this fact and that the have understood this.
All births will be reported to the Health Department – already a legal requirement.
As well as this, midwives will need to adhere to a Quality and Safety Framework. This Franework is in the hands of the Nursing and Midwifery Board at the moment and until it is placed in a code or guideline, it is not intended to be folowed. Indeed, we only have a final draft, so cannot follow it as it has not been released.
The bottom line is: homebirth is not illegal!!
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Home birth, Maternity Services Review, midwife, Midwifery, Midwifery services
Posted by Melissa Maimann on Jun 23, 2010 in
Birth,
Home birth,
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Can private midwives be fined for delivering a baby at home?
No. it’s perfectly legal for private midwives to attend homebirths. There are no fees or penalties to the midwife or family.
What is an eligble midwife?
An eligible midwife is a midwife who has:
Current general registration as a midwife in Australia with no restrictions on practice;
Midwifery experience that constitutes the equivalent of 3 years full time post initial registration as a midwife;
Current competence to provide pregnancy, labour, birth and post natal care to women and babies;
Successful completion of an approved professional practice review program for midwives working across the continuum of midwifery care;
40 hours per year of continuing professional development relating to the continuum of midwifery care (20 hours in addition to standard requirements);
Formal undertaking to complete an accredited and approved program of study to develop midwives’ knowledge and skills in prescribing within 18 months.
Clients of eligible midwives are able to access Medicare benefits for the services provided by eligible midwives. eligible midwives are also able to access visiting rights at a later date.
Can you use a private midwife in public hospital in sydney?
Yes. You can work with a private midwife during your pregnancy and she can provide all of your pregnancy care. You can labour at home as long as you like with your private midwife, moving to hospital when you feel ready. In hospital, your midwife will ensure that your needs are met and provide support and advice. After your new family member arrives, you can return home and be cared for by your private midwife.
Sometime after November, private midwives will have visiting access to hospitals.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Home birth, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Jun 14, 2010 in
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
Houston, we have a problem.
At July 1, 2010 eligible midwives must work in a collaborative agreement with an obstetrician. This agreement must be signed by the obstetrician. It legitimises obstetric control over women’s choices. Even basic choices such as limited (or no) vaginal examinations in labour, refusal of continuous monitoring in women who are planning a VBAC, delayed (or no) induction and so on. Of course, it also depends on how reasonable the obstetrician is.
You see, in order for an eligible midwife to be insured for her practice, she must work collaboratively with an obstetrician and this is evidenced by a signed collaborative agreement. No signed agreement = no collaboration = insurance will not respond to any claims and therefore the midwife is working uninsured (and therefore outside the conditions of her registration) and may be de-registered.
Once in the collaborative agreement, the midwife, woman and obstetrician must reach agreement about the plan of care if the woman’s condition is classed as a B or C in the ACM Guidelines.
What sorts of conditions are listed as B in the Guidelines?
Previous post-partum haemorrhage
Hypothyroidism
Weight over 100kg
History of mental health disorders
Mild asthma
IVF pregnancy
Previous forceps or vacuum delivery
Having baby number 5 or more
Previous shoulder dystocia
VBAC
Long labour (<1cm/hr progress)
And the list goes on. These women must have a consultation with an obstetrician and the ongoing plan of care must be agreed by the woman, midwife and obstetrician.
What sorts of conditions are listed as C in the Guidelines?
Type 1 diabetes
Coagulation disorders
Lupus
Twins
Pre-eclampsia
Breech in labour
Gestational diabetes requiring insulin
Prem labour
And so on. These women cannot be cared for by a midwife; their care must be transferred to an obstetrician. The midwife’s continued involvement in the woman’s care must be agreed by the obstetrician. Even though the woman engaged the service of the midwife, has a contract of care with the midwife and has paid her midwife.
There is no right of refusal. The midwife will consult with an obstetrician on the woman’s behalf if the woman refuses to consult in person. If the obstetrician does not agree to the plan of care – the midwife cannot continue care of the woman because the woman’s condition is considered outside the scope of the midwife’s practice (and therefore outside of insurance and registration).
This system of collaboration is in place in other countries such as The Netherlands, NZ and Canada. The difference in those countries is the professional respect and standing of midwives that enables them to act as autonomous care providers to their women. Have you read The Birth Wars? Read it – it’s an eye opener and provides great insight into the current maternity system. Nicole Roxon wants obstetricians and midwives to work together. It seems she’s thrown us all into the bucket and simply said, “make it work!”. Unfortunately, entrenched attitudes and beliefs do not change quickly.
Collaboration will work when:
Collaborative agreements are negotiated at College level, not local level.
Obstetricians are mandated to require with collaborative agreements. At present they can refuse to sign a collaborative agreement.
Midwives have an avenue for appeal if they – or their clients – are treated unfairly.
Visiting rights are in place.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Complicated pregnancy or birth, continuity of care, Maternity Services Review, midwife, Midwifery services, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on Jun 13, 2010 in
Midwifery Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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LEGISLATION giving midwives greater authority over the maternity care of Australian women will be launched at the end of the month, but it could take years before real changes are delivered.
The new legislation … marks a ”major cultural shift” in the provision of maternity care, according to Patrice Hickey, Victorian president of the Australian College of Midwives.
But, it will take up to five years for the shift from hospital-based pregnancies to a significant number managed by private midwives in superclinics to take root, she said, because most Victorian midwives did not realise the laws applied to them.
Ms Hickey said the highly publicised controversy surrounding the role of midwives in home births had obscured the issue. She said the wide-ranging review found women wanted continuity of care during their pregnancies, with one midwife as the primary carer.
… ”This is a major cultural shift that no one has paid attention to because a lot of people thought it was about the home-birth issue,” said Ms Hickey.
One of the predicted major changes will mean a significant number of hospital-based midwives moving into private practise, setting up offices alongside GPs and physiotherapists in superclinics.
… The new legislation is meant to take effect on July 1, but it is still bedevilled by a number of unresolved issues, including:
■ Whether access arrangements for midwives to attend births in hospitals will be governed at the state level or by the Commonwealth.
■ What services Medicare will cover – which means that midwives cannot yet decide what to charge their clients …
All midwives in private practice – regardless of whether they attend labours and births in a hospital or at home – will have to meet new criteria related to an ”eligible”’ midwife status for Medicare access and the Pharmaceutical Benefits Scheme.
… The insurance will cover prenatal and postnatal care, and attending labour and births in hospitals, but not home births. The arrangements were confirmed last week …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, Home birth, hospital birth, Maternity Services Review, midwife, Midwifery, Midwifery services, Public and private hospitals
Posted by Melissa Maimann on Jun 12, 2010 in
Home birth,
Midwifery,
Obstetrics Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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The 11 June issue of Australian Doctor carries a story … that is truely gob-smacking.
… the NHMRC has been trying to organise a meeting between the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Australian College of Midwives to develop an agreement on referral guidelines in relation to midwives being able to access the Medicare Benefits Schedule … provided they work “collaboratively” with doctors.
… RANZCOG has … refused to attend the meeting because community representatives who support homebirths have been invited.
If you were ever in doubt about the need for reform of maternity services, then look no further.
If you were ever in doubt about why reform in this area is so excruciatingly difficult, then look no further.
And if you were ever in doubt that professional interests rule in the health sector, then look no further.
This really is pathetic. Absurd and childish are other adjectives that come to mind….
It’s simply business. Midwives and obstetricians essentially compete for the same low risk women. Every low-risk woman who sees a midwife is one less woman seeing an obstetrician. Most women are low risk. Obstetricians cannot afford to lose the bulk of their “business” to midwives and unfortunately, collaborative agreements favour obstetricians in several ways:
- There is no onus on the obstetrician to collaborate, and for every midwife who cannot get a signed collaborative agreement, that’s one less midwife in private practice and therefore more women woo will see private obstetricians.
- There is no onus on the obstetrician to return the woman to midwifery care once the indication for referral no longer exists. Indeed, there is a great incentive for the obstetrician to “keep” the woman: $$$.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Birth choices, continuity of care, Maternity Services Review, midwife, Midwifery services, Obstetrics
