The end of private midwifery practice in Australia

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email me or call 0400 418 448. THE HON NICOLA ROXON MP MINISTER FOR HEALTH AND AGEING


Midwives/ Nurse Practitioner Amendment

The Minister for Health and Ageing, Nicola Roxon has today circulated an amendment the Government intends to introduce ... this amendment will simply clarify in legislation that collaborative arrangements with medical practitioners will be required to access the new arrangements.

... These bills are a key plank of the Government’s 2009/10 Budget commitments which recognises for the first time the role of appropriately qualified and experienced midwives ... in our health system.

The International Definition of a Midwife, as accepted by FIGO, ACMI and the International Confederation of Midwives states:

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the newborn and the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare.

A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.

When the Minister's Media Release is read in conjunction with the ICM definitoin of the midwife, we can see how contradictory the Minister's Media release is.

On the one hand, midwives will be required to work collaboratively with obstetricians or GP OBs, yet on the other hand, the Minister states how this "recognises for the first time the role of appropriately qualified and experienced midwives ..." How so? If private mdiwives are required to work collaboratively with obstetricians, how are we working to the ICM definition as autonomous practitioners in our own right?

It will be interesting to walk this path as it plays out. Will obstetricians have the same requirement to collaborate with midwives? Will they have to ensure that all of their private patients have a private midwife too in order to access PBS, MBS, insurance, and indeed to register?

Possibly what would be a better system is a private health system that recognises midwives as experts in normal pregnancy and birth, and obstetricians as experts in abnormal pregnancy and birth. We need nationally-accepted guidelines for OBs and MWs that state whom the appropriate care provider is, and at what stage. Midwives have Guidelines for practice, as do obstetricians, however they are not the same. We would simply need to mesh these guidelines to form national gudelines for maternity care providers which would ensure that healthy, low risk women see midwives, maybe with one appointment to meet the backup obstetrician, and that women with risk-associated pregnancies see obstetricians in association with a private midwife, given that a midwife will be present at every birth.

Certainly, as this legislation stands, it does spell the end of private home birth. RANZCOG has recently issued a statement that clearly indicates their refusal to sanction home birth. What private obstetrician will work collaboratively with a private midwife who is intending to birth with women at home? Extending this further, will a private obstetrician refuse to collaborate with a private midwife who intends to birth with women in hospital if the midwife's clients refuse say an induction at term plus 10, active management of the third stage, a vaginal examination in labour etc? These are important questions to ask. It seems that going beyond July 1, 2010, right of refusal will only exist in the public health system and midwives will not be able to work in private practice on their own authority.

Solutions, anyone?

Melissa Maimann, Essential Birth Consulting 0400 418 448