The future of private midwifery

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email me or call 0400 418 448. There has been stong interest on the issue of the future of private midwifery since the Health Minsiter's announcement that clarified the meaning of "collaborative practice". Collaborative practice will mean that every private midwife must have a collaborative agreement with a private obstetrician who can effectively sign off on the midwife's work. If s/he does not agree with the plan of care for the woman, the obstetrician may sever the collaborative arrangement. Furthermore, with RANZCOG and the AMA being opposed to home birth, home birth will not be an option in the private system, as it is currently. The exemption that was granted to home birth will have no meaning since collaborative arrangements will be a requirement for registration for private midwifery practice.

There are several issues:

- Midwives will no longer be able to practice in accordance with the International Definition of the Midwife. In the current climate of a world-wide midwifery shortage, it makes no sense to prevent currently practicing midwives from continuing to practice. - Midwives' practice will be subservient to obstetric practice, potentially increasing Australia's already high caesarean, induction and epidural rates. This, of course, increases morbidity for mothers and babies and compromises Australia's safe record of maternity care. - It is likely that obstetrician's insurance will forbid them from working with midwives unless the midwife works very closely with the obstetrician, for example in the obstetrician's rooms. The obstetrician's insurance company will no doubt not want the obstetrician to be taking responsibility for things that s/he has no direct control over (despite the fact that the midwife will have insurance too). - Home birth will not be an option in the private setting. Publicly-funded models will remain an option, but these are few and far between. - Private midwifery care in hospitals will restrict women's choices, eg vaginal breech, vaginal twins and so on. It is highly unlikely that an obstetrician will agree to work collaboratively with a midwife who is supporting a woman to have say a vaginal breech birth. - The net effect will be the erosion of women's choices, especially in the private system, and the restriction of a midwife's practice to employed models within hospitals.

No other profession is denied the opportunity to practice privately. No other profession is required to have sign-off from a different profession. And no other profession is legislated against providing the full scope of care by international definitions.

While it is clear that the maternity reforms are not intended to be in any way related to home birth, it now seems that even private midwifery care for hospital birth is under complete threat of extinction.

Melissa Maimann, Essential Birth Consulting 0400 418 448