"Do midwives need a doctor to share care and collaborate for home births?"

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. There is much confusion about the maternity reforms, medicare, collaboration and homebirth.

The simple answer is that is a midwife / woman wish to claim medicare benefits, a collaborative agreement is needed. The collaborative agreement is between the midwife and specialist obstetrician, or midwife and GP obstetrician. A collaborative agreement can take a few forms: - a written referral from the doctor to the midwife (respective of each and every woman) - a written agreement between the doctor and midwife (1 agreement to cover several women) - midwife's written record of a collaborative arrangement (lots of paperwork for the midwife for each woman she has booked with her) - a midwife being employed or engaged by a business that employs obstetricians (this may be possible if the midwife has clinical privileging at a hospital, or if a midwife is employed by an obstetrician).

If the woman / midwife do not wish to claim medicare, a collaborative agreement is not needed. In this sense, there is no "medical veto" or a doctor's signing off of a homebirth.

Medical veto does not exist where a midwife and obstetrician are working together in partnership, each respecting the skills, experience and knowledge that each one brings. Since signed collaborative agreements are ony one option of several, and since midwives and obstetricians can choose whom they wish to have agreements with, it would surprise me that a midwife would voluntarily sign an agreement with an obsetrician who would veto her practice. These discussions would surely be had well before an agreement was signed.

Women who are wishing to claim medicare benefits for private midwifery care will need to ascertain that their midwife is an eligible midwife. Unfortunately the Board has no process as yet to assess applications for eligibility, so there are no midwives who are currently eligible. It is hoped that this proces will be in place in the next few weeks. In any case, women should verify that their midwife: - has registration as a midwife with no conditions on their registration - has completed a professional midwifery practice review - has attended 40 hours of continuing professional development in the past year - has competence across pregnancy, labour, birth and postnatal - has at least three years of experience

These are the requirements for midwives who wish to apply to be eligible. Clients of medicare eligible midwives may claim medicare benefits provided that the midwife has a collaborative agreement as described above.

Confused? You're not alone! Email me with any questions.

Melissa Maimann, Essential Birth Consulting 0400 418 448