Access For Pregnant Women To Medicare Funded Midwifery Care On The Way: But not for homebirths


... Heath Minister Nicola Roxon has today introduced the first bills to legislate giving women access to Medicare funding for expert midwifery care.

It doesn't. Expert midwifery care is provided by the minority of midwives who provide continutiy of care - eg for homebirths. Women, as a whole, will not be able to access this care because few midwives provide it.

“This is historic legislation for childbearing women and their families” said Dr Barbara Vernon, Executive Officer of the Australian College of Midwives.

Yep - it is. For the first time in Australian history, women are denied the right to have amidwife-attended homebirth. Great step forward!

“From November next year, women will be able to choose the care of a midwife to provide their pregnancy care in the community, follow the woman into hospital to provide her labour and birth, and follow her home again afterwards to provide the vital professional support in the early weeks of caring for a newborn baby”.

So long as the woman births in hospital.

The government’s bills will pave the way for women to receive Medicare rebates for private midwifery care, as well as providing for Pharmaceutical Benefits Scheme rebates for relevant tests and drugs. One bill will specifically support eligible midwives to access professional indemnity insurance for their care.

... Midwives, working collaboratively with GP obstetricians, will help meet women’s need for local care.

Collaborative care has not been defined and most likely there will be several hoops for midwives to jump through in order to access MBS and PBS and insurance. I wonder if the current midwives who work independently of the hospital system will be eligible.

“This national legislation recognises for the first time that midwives make a valuable contribution to maternity care in their own right.

Actually, it doesn'yt. It places midwifery fairly and squarely under obstetric dominance. It affords midwives some rights that they already have in hospital, provided they work with a doctor and ensure that their clients follow the obetetric rules. The new laws place midwifery subservient to obstetrics. Imagine if GPs were only able to practice provided they worked in a collaborative team with a nurse, pathologist, radiographer etc? Imagine if an obstetrician was only able to practice if they worked collaboratively with a midwife, referring all women to the midwife if the woman is low risk and healthy?

Midwives who provide Medicare funded care will work collaboratively with doctors and other health professionals to ensure the individual needs of each woman and baby are fully met.

The needs of women will only be met when they have the final say. What if the woman declines a cosultation with the onstetrician? What if the woman makes an intelligent decision not to have certain tests? Will the midwife be able to support her? The midwife will cease to be "collaborative" if the woman does not comply. So is this an attempt to use an acceptable (to the woman) person (ie, the midwife) to coerce women to have tests, consults and care that she does not want, or perhaps need? I can't help but this it's the govt's way of using midwives to assert control over women.

...“These reforms will not only give women greater choice than they currently have, they will also give most midwives more choice about how and where they provide care to women, thereby helping to reduce stress and loss of midwives to the maternity care workforce.”

So long as it is within the confines of the hospital and so long as the woman and midwife play by the rules of the hospital. I doubt a doctor will work collaboratively with the midwife if the midwife's clients decline synto for the third stage, decline routine induction, decline a diabetes screen, or insist on having a VBAC. If the midwife is no longer in a collaborative team, she no longer has insurance (and therefore registration) or access to PBS and MBS.

This is perhaps the only part I agree with:

“The only dark cloud in these historic reforms is that they will not provide for women who choose to give birth at home under the care of a midwife. There is mounting international evidence that the option of birth at home is safe for low risk women. ACM is concerned that the rise in unattended homebirths will only get worse unless the government extends its proposed indemnity scheme to ensure healthy low risk women can continue to choose homebirth with competent networked midwives.”

This has all come out of the maternity services review, in which 53% of respondents were women who demanded homebirth services to be provided by midwives. Is the govt listening? Does anyone really care?