Update on national registration and its effect on homebirth

For further information, contact Melissa Maimann at Essential Birth Consulting. The design of the New National Registration and Accreditation Scheme has now been published.

I was initially optimistic since the report does not mention insurance being tied to registration. I thought that perhaps insurance would not be a requirement of registration. My professional body, ACMI, have informed me today that insurance may still be linked to registration.

There is also a new clause: "Mandatory reporting of registrants". This clause states that:

"there will be a requirement that practitioners and employers ... report a registrant who is placing the public at risk of harm.

... reportable conduct will include conduct that places the public at substantial risk of harm either through a physical or mental impairment ... or a departure from accepted professional standards. ... This requirement will deliver a greater level of protection to the Australian public.

Protection of the public is an important concern. However, we also have a situation where the AMA and RANZCOG are opposed to home birth and free-standing birth centres. We also have Guildelines for Consultation and Referral, set out by the College of Midwives. The effect of this may be to limit private home birth services. In essence what it could mean is that all moderate and high risk pregnancies and births will need to be consulted to, or even referred to, an obstetrician for management. The Obstetrician, belonging to the AMA and RANZCOG, would most likely advise against home birth. If the midwife and woman proceed with a home birth, under the mandatory reporting of registrants, the midwife can expect to be reported to the Board for placing the public at risk of harm. The midwife, at all times, must act within her scope of practice - primary care provider for normal pregnancy and birth - and must act according to professional guidelines. Undertaking a home birth that was advised against by a doctor (for any reason) may leave the midwife open to being reported to the Board, and ultimately de-registered.

Sounds fair and reasonable? Perhaps, but what about the rights of women to choose where, how and with whom their baby will be born?

Luckily, women may take a private midwife with them to a hospital birth, and although the private midwife may not necessarily act as the accoucher for the birth, the advocacy and advice is invaluable, not to mention continuity of care and ongoing support. However, this does not help women who prefer to have their VBAC, breech or twin babies at home. I think it's time for women to take a stand and demand private midwifery for home and hospital birth.

Melissa Maimann, Essential Birth Consulting 0400 418 448