Collaborative Agreements

Visit my website to learn more about my services. The Government's $120 million national Maternity Reform Package is currently being implemented. There is still much work to do. From 1 November 2010, women will be able to claim Medicare benefits from care that is provided by eligible midwives. Women will need to ensure that their midwife is eligible, prior to engaging her services, if she wishes to claim medicare benefits.

It is still not known how much women will be able to claim through medicare and these details will not be known until closer to November 1, 2010.

Midwives have been lobbying hard around the one key sticking point of these reforms: how midwives and obstetricians will work together in defined collaborative agreements. The Maternity Services Review recommended that medicare be extended to midwives who work in collaborative agreements with obstetricians, however the definition of collaboration has only just been revealed.

The definition of a collaborative arrangement provides for four options, each requiring signed agreement from the obstetrician. No collaborative agreement = no medicare benefits for the woman.

One option is a contract of employment whereby the midwife is employed by the obstetrician. Personally, I would have suggested that this go the other way around: considering that most women have healthy pregnancies and do not require the services of an obstetrician, the midwife ought to employ the obstetrician on a sessional basis for her private clients when obstetric services are required.

Option two requires that the obstetrician refers a woman to a midwife for midwifery care. I truly cannot see this option working in the private health system. What incentive is there for the obstetrician to refer his/her patients to a midwife?

Option three requires a signed collaborative agreement between the midwife and obstetrician. But there’s a catch: no obstetrician is on call for 24/7/365. Hence, at least two obstetricians will need to sign this agreement for it to be in force 24/7/365. What should happen when one partner wishes to pull out, goes on leave, has a holiday and so on? This suddenly leaves the midwife – and all of her private clients – without an agreement, without medicare and without care.

Option four requires oodles of paperwork on the midwife’s part. I don’t mean to be negative but it would work out to be: spend one hour with the woman and one hour chasing the paperwork. Yes, there’s a *lot* of paperwork. And every time a piece of paper is forwarded to the obstetrician, the obstetrician must acknowledge receipt of this. There are at least seven points in the pregnancy where a midwife will need to photocopy and fax / post; or scan and email documents to the obstetrician and then document that the obstetrician has acknowledged receipt of these documents. A nightmare for all!!

So where are we going with all of this and what is the big picture? The big picture as I see it, is that sometime towards the end of the year, eligible midwives will have visiting / admitting rights at hospitals. Their clients will be able to claim medicare benefits for their services for the very first time, bringing down the cost of private midwifery care significantly. Women will be able to book with their private midwife of their choice, and also be admitted to hospital for birth under the care of their chosen private midwife, presumably as a private patient. If obstetric care is needed, the midwife would have ready access to a named obstetrician who could assist the woman, enhancing continuity of care to the woman. This system would provide true continuity of midwifery and obstetric care to women.

However, we have a long way to go. The collaborative agreements, as they stand, require an obstetrician’s sign off before the midwife can provide medicare-rebatable services to women. Some obstetricians, it seems, are very supportive of an employment model whereby the midwife is an employee of the obstetrician, however for the midwife who has her own successful and thriving business, this option will not be satisfactory. Much work needs to be done to explore models of care, facilitate visiting rights for midwives and protect the right of the midwife to practice as an autonomous practitioner, a specialist in natural birth.

Melissa Maimann, Essential Birth Consulting 0400 418 448