Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email me or call 0400 418 448. Below is an important brief that has been prepared by Bruce Teakle of Maternity Coalition. It explains what the situation will be after July 1, 2010 for private midwifery practice for home birth and hospital birth. It affects all women who may be birthing their babies after July 1, 2010.
On 5 November the Government announced that the “Medicare for midwives” Bills would be amended to require midwives to have “collaborative arrangements” with “medical practitioners” before being eligible for professional indemnity insurance or Medicare rebates:
* before the midwife can access professional indemnity insurance, and
* before women can claim a Medicare rebate for midwifery services.
Doctors must approve each midwifeʼs entry to private practice: * Midwives will be required by Commonwealth law to have “collaborative arrangements” with “one or more medical practitioners” before being eligible for Commonwealth-subsidised professional indemnity insurance (PII).
* PII will be a prerequisite for a midwife to enter private practice, under new national registration laws, being enacted state by state.
* Doctors will be able to unilaterally withdrawal from collaborative agreements with a midwife, rendering her uninsured, and legally unable to practice in a private professional capacity.
* This legally mandates medical control over midwives’ ability to register and work in private practice.
* This will be set in Commonwealth law, which can only be changed by Commonwealth Parliament.
* These provisions are contained in the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009.
Doctors must approve womenʼs access to Medicare rebates for midwifery care:
* Midwives will also be be required by Commonwealth law to have “collaborative arrangements” with “one or more medical practitioners” before their services are eligible for Medicare rebates.
* This puts women’s access to private midwifery care under medical control.
This is potentially defacto “parallel regulation” of the midwifery profession: * Medical practitioners will control the registration status of midwives, despite their being a discrete, separately regulated profession.
* Medical professional organisations could set guidelines for collaborative arrangements, potentially forming defacto regulatory standards for midwifery endorsement and practice.
This gives doctors right of veto over womenʼs choices in birth care: * Any birth care choice using private practice midwives, or developed under the Commonwealth’s new arrangements, will be subject to medical control or veto.
* This gives medical practitioners unprecedented control over women’s choices and access to care.
“Collaborative arrangements” may be legally restricted to privately practicing doctors * The amendments do not specifically include hospitals as able to form collaborative arrangements with midwives. They require medical practitioners to be “of a kind or kinds specified in the regulations”.
* It is unclear whether a hospital, health service district or authority may be included within the definition of “one or more medical practitioners”.
* Doctors who are employees of public hospitals can’t make “collaborative arrangements” as employees of the hospital they work for. They work for the hospital, attend their workplace when rostered on and collaborate in line with hospital policies.
* A range of very serious consequences would flow if these arrangements were restricted to privately practicing doctors. Consequences could include:
o No new midwifery models in public hospitals. o No private midwifery practice. o No homebirth care from midwives in private practice. o Practice midwives in private obstetricians rooms could be the only viable model of private practice or Medicare-funded midwifery.
This brief represents the best information available to Maternity Coalition on 8 November 2009. We are actively seeking ongoing clarification and dialogue with Government in order to ensure women and families have access to accurate information. For full text of amendments click here. For more information contact: Bruce Teakle 07 3289 0231