An article in The Sydney Morning Herald has explained the difficulties that eligible midwives are facing in their practices. More than 18 months after the federal government gave private midwives the possibility of improving choice in maternity care, across the country, very little has changed. Between November 2010 - when private midwives were entitled to apply and become Medicare providers - and the present time, only 97 midwives have done so. I have been informed that there are around 200 eligible midwives around the country, but only 97 are able to use their Medicare provider status.
A midwife can apply to our registering authority to become an eligible midwife. An eligible midwife meets certain advanced practice requirements:
- Current general registration as a midwife in Australia
- Midwifery experience that constitutes the equivalent of 3 years full time
- Current competence to provide pregnancy, labour, birth and postnatal care to women and babies;
- Successful completion of an approved professional practice review program for midwives working across the continuum of midwifery care;
- 40 hours per year of continuing professional development relating to the continuum of midwifery care (20 hours in addition to standard requirements)
Once a midwife has met those requirements, s/he may apply to the registering authority for notation as an eligible midwife.
But this is not sufficient to become a Medicare provider: in order to be a Medicare provider, a midwife must have a collaborative arrangement with an obstetrician or a doctor who provides obstetric services. And this is where the issue lies. Across the country, midwives do not have widespread access to admitting rights, and doctors are refusing to collaborate with midwives.
The government will now need to decide how to proceed as the collaborative arrangement requirement is not working or workable, for so many reasons. Reasons cited by obstetricians include:
- I have a busy practice and don't wish to add an additional workload
- I like the way I practice and at this time, am not prepared to consider a different way of working
- I don't collaborate with private midwives
- I don't feel that it is appropriate to collaborate until such time as midwives have access to hospital admitting rights
and so on.
Each argument is equally valid, and one cannot be compelled to collaborate if one does not wish to. However, a midwife's practice should not be restricted because another person has declined to collaborate.
Personally, I am disappointed at this situation. For the past 18 months, I have successfully collaborated with an obstetrician and our model of care is delivering excellent care and outcomes to women and babies. There is a very high level of satisfaction with this care, and low rates of intervention. The model of care supports women regardless of risk factors. Women have primary midwifery care, but with known and supportive obstetric back-up if need be. This is well within all guidelines, policies and best practice, yet we seem to be the only midwife-obstetrician team in the country to have a model of care that supports women from pregnancy, through to birth and postnatal care. It's not rocket science! It's simple and it makes sense and it works. I would be disappointed if the requirement for collaboration was relaxed because obstetricians are refusing to collaborate, because there is the potential for advserse outcomes for women and babies if midwives cannot secure trusted, supportive and accessible consultation if this is needed.
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