Insurance Plea for Homebirth Midwives

Sydney Morning Herald
Kate Benson Medical Reporter

June 30, 2009

A CORONER handing down findings into the death of a baby born at home has called on the Federal Government to rethink its refusal to indemnify private midwives outside hospitals, saying home births will be driven underground with "disastrous ramifications".

In releasing his report on Jasper Kosch-Coyne, a newborn baby who died while being driven from his parents' farm to Nimbin hospital two years ago, the Byron Bay coroner, Nick Reimer, said home-birthing was a mother's inherent right and a practice "that will not go away".

Last month the federal Health Minister, Nicola Roxon, announced that private midwives would be given access to Medicare provider numbers and prescribing rights from next year, but indemnity insurance would not be extended to midwives attending home births.

"History has shown there will always be a small group of expectant mothers who will want to give birth in their home," Mr Reimer said. "Birthing at home should be an available option."

In an unusual move, he sent the Kosch-Coyne inquest findings to the federal and state health ministers, urging them to exercise "great care" in drafting legislation that would make home-birthing illegal.

The inquest found that baby Jasper died about midnight on July 18, 2007, after the midwife, Jillian Delaile, failed to seek help when it was clear he could be swallowing meconium in the womb. Ms Delaile had attended the birth on her own, had not organised transport in case of an emergency and did not transfer Jasper's mother, Angel Kosch, to hospital before delivery even though she had requested it because her labour had become difficult and protracted. The inquest was told the baby's heart rate was not monitored adequately and Ms Delaile failed to call an ambulance when the baby was born breathing inadequately with the umbilical cord wrapped tightly around his neck.

She left Ms Kosch at home to deliver her placenta with no medical assistance while she travelled in a car to Nimbin hospital, performing cardio-pulmonary resuscitation on the baby in the front seat.

Ms Delaile had asked a family member to administer an intramuscular injection to Ms Kosch if she began hemorrhaging. Ms Delaile was cleared of responsibility for the tragedy because there had been a "series of shortcomings" and it was not possible to conclude any of them had contributed to Jasper's death, Mr Reimer said.

But a spokeswoman for the Australian College of Midwives, Hannah Dahlen, said such tragedies would become more commonplace if home-birthing was made illegal.

"Women have said they will have no option but to freebirth, midwives have said they will work so far underground no one will ever find them, people will fail to register home births and there will be a reluctance to transfer [a woman to hospital] when there is an emergency," Ms Dahlen said.

"No country has ever been able to eradicate home-birthing. The system will simply become unchecked and dangerous."

The secretary of Homebirth Australia, Justine Caines, said more mothers and babies would die if home-birthing became illegal. "Women will continue to homebirth, but will do so without the assistance of a qualified professional … removing women's rights to the point where we are back providing care in dark alleys or in back rooms, is ridiculous in 2009."

Deaths will increase with new announcements

Homebirth Australia today slammed the exclusion of homebirth from insurance schemes for midwives announced by the Health Minister Nicola Roxon in parliament today.

"Effectively two pieces of legislation will outlaw midwives providing homebirth care from July 2010" said Justine Caines, mother of seven and secretary of Homebirth Australia.

"Women will continue to homebirth, but will now do so without the assistance of a qualified professional." said Ms Caines. "The result will be an increase in deaths for mothers and babies, this is certain. It is absolutely impossible to understand the government's position on this, other than to say that they have bowed to political pressure from medical lobby groups."

The National Maternity Service Review received submissions from hundreds of women wanting access to homebirth services. The vast majority of homebirth services are provided by private practice midwives. Removing this option is likely to end access for most women to homebirth.

Ms Caines called on all ALP members to declare their view on a woman's right to self determination of her health care needs. "If the ALP is so hell bent on preventing women from accessing homebirth as an option I ask all ALP members to publically state their position on this. It appears that having a Health Minister who is a woman, a recent mother, and a lawyer understanding consumers' rights, is not proving to be an advantage for women. Removing women's rights to the point where we are back providing care in dark alleys or in back rooms is ridiculous in 2009."

Australian College of Midwives Media Release

Media Release, June 2009
Mothers and babies at risk: Access to qualified midwives for homebirth under threat. Private midwives will no longer be able to attend homebirths under new national laws proposed for registering health professionals to have effect from 1 July 2010.

The national registration scheme for health professionals, which has been being developed by COAG and health ministers since 2007, released the draft laws last week. One of the requirements of the new scheme will be that all health professionals have professional indemnity insurance, as a measure to ensure consumers have access to compensation if they successfully prove negligence.

But private midwives have been unable to buy professional indemnity insurance since 2001. Most midwives are indemnified by their employers, typically a public or private hospital. But midwives in private practice are the ones who have historically provided women with access to the choice of giving birth at home. Access to indemnity for private midwives ceased in 2001 following the collapse of HIH and September 11, which caused insurers to reassess their liabilities.

“The national registration laws will require a midwife to be indemnified for all areas of her practice. This will effectively make it impossible for a midwife to legally care for women planning homebirth, because there is no professional indemnity available for homebirth care” said Dr Barbara Vernon, Executive Officer of the Australian College of Midwives. “This is devastating news for private midwives, as this policy threatens to throw them onto the unemployment queues” Vernon said.

“It’s also a very dangerous move by registration officials” Vernon said. “It is essential that women who choose to give birth at home have access to experienced midwives. The widely reported tragic death in March of a baby born at home without a midwife or doctor in attendance is testimony that unattended homebirth is dangerous.”

“Midwives have knowledge and skills that ensure women who labour at home can do so safely. They closely supervise the labour to ensure that everything is proceeding normally, and can arrange for timely transfer if they are not. They also have skills and equipment to perform life saving emergency care in the unlikely event of a mother or baby need urgent transfer.”

“The Australian College of Midwives is gravely concerned that if midwives are prevented from providing professional care to women planning homebirth, that some women will proceed to birth at home anyway, unattended. Any attendant they might have would not be a regulated health professional like midwives are, accountable to competency standards, codes of ethics and conduct, and required to maintain professional knowledge and skills. This is a retrograde step”.

Health Minister, Nicola Roxon is set to introduce legislation to federal Parliament soon that will assist private midwives to access professional indemnity insurance. This assistance will be for midwives who become eligible to provide Medicare funded care to women in the community for pregnancy and postnatally and for labour and birth in a hospital.

“We welcome the Minister’s recognition of the valuable contribution midwives make to maternity care evidenced by the Budget decision to give Medicare and PBS rebates to women or care by eligible midwives” Vernon said. “The support for eligible midwives to access insurance for such care is also vital given the market failure in this area of insurance”.

“Now that the national registration laws will effectively render it illegal for midwives to attend women planning homebirth, it is vital that the government’s support for midwives to access indemnity insurance is extended to include women who choose to labour and birth at home” Vernon said.

“This is the only option if the government is serious about maintaining safety and quality for all women needing maternity care in Australia”.

Law to stop midwives working outside hospitals | The Daily Telegraph

By Kate Sikora

June 19, 2009 12:00am

HOMEBIRTHS will become illegal under tough new laws that prevent women using midwives to have children outside hospitals.

The move is set to drive homebirths underground, with expectant mothers and their babies at risk.

There are fears women determined to have a homebirth will "go it alone" like birthing advocate Janet Fraser, whose baby died during a natural water birth in April.

Under the draft Health Practitioner Regulation National Law, released last week, a midwife cannot be registered unless she has insurance.

But with insurance companies and the Government so far refusing to include homebirths in the indemnity scheme, midwives will face being de-registered if they attend a homebirth.

Women's groups accuse the Rudd Government of stripping women of rights by forcing them into hospitals.

Australian College of Midwives boss Dr Barbara Vernon said the Government's intention was obvious.

"I had been optimistic until now when you can see it in black and white," she said. "Even though only less than half a per cent of women have homebirths, they should have the same rights as a woman who chooses to have a caesarean. Homebirths won't stop."

About 150 midwives do homebirths in Australia. Called independent or private midwives, most do not work in a hospital and are uninsured.

But from July 2010, they will no longer be able to call themselves midwives even though they are trained. Only those insured and registered can use the term midwife, otherwise they face a $30,000 fine.

There are about 700 homebirths a year but some say this may be as high as 2100 as they are under-reported.

For TV presenter and marriage celebrant Elizabeth Trevan, giving birth to her 18-month old twins Nash and Harvey at home was an "overwhelming experience."

"It breaks my heart to hear that the Government will do this," she said. "This is about choice.

"The Government should be driving this and helping midwives who want to (do) homebirths. They will never be able to afford insurance."

Home Births Australia secretary Justine Caines said the new law took away the rights of women.

"It technically makes homebirthing illegal," she said.

The Royal Australasian College of Obstetricians and Gynaecologists is against homebirths.

Visit to Alex Hawke

I visited Alex Hawke, the federal member for Mitchell (Castle Hill and surrounding area) with a group of women from his electorate. Alex has made a commitment to fight for the right of women to birth at home. He has raised the matter with the Shadow Health Minister and raised the matter in parliament on Monday 15th June 2009. To view Alex's speech - click here

Maternity units cut despite baby rush | The Australian

Maternity units cut despite baby rush | The Australian
AUSTRALIA is delivering record numbers of babies, despite losing a sixth of its public hospital maternity wards over the past decade.

Despite rising fertility rates and population growth, the number of obstetric and maternity services offered by state-run acute-care hospitals has plummeted from 298 in 2000-01 to 248 in 2007-08.

Neonatal intensive care and specialist pediatric services have also become scarcer in the public sector at a time when most other specialist units grew in number.

The Australian Institute of Health and Welfare data shows the bush suffered the steepest decline in maternity services, with medical workforce shortages and low volumes of births speeding closures.

Australian Medical Association president Andrew Pesce, an obstetrician, acknowledged that many women were travelling away from home, sometimes several hundred kilometres, to give birth to their child.

"There's real difficulty delivering maternity services outside the metropolitan areas" and it was difficult to attract people with skills to some areas, he said.

Governments should make the best use possible of local facilities, but could not be expected to provide every maternity service in all places, for safety reasons, Dr Pesce said.

"Often they're small units doing a small number of deliveries, and they don't have the nursing, the midwifery or medical expertise available to provide a safe, co-ordinated service," he said.

Justine Caines, a member of the Maternity Coalition executive, said state health services had been too quick to use obstetrician shortages as an excuse to abandon local maternity units, arguing midwives could provide substitute services if current rules were relaxed.

She said so many expectant mothers were being referred to larger regional or city hospitals that those services, too, were struggling to cope.

Even in the biggest hospitals, some birthing units were so overwhelmed they required mothers to register within weeks of conception or, in one case, used a lottery system to decide who they could take, Ms Caines said.

"Why has this been allowed to happen when the midwifery workforce has been there forever, willing and able and yet prevented from practice by funding arrangements?" she said.

The reduction in services has coincided with a multi-year baby boom that has taken demographers by surprise.

Australia is expected to register almost 300,000 births in 2008, surpassing the previous record of 287,000 in 2007.

In recent years it has reversed a falling birth rate to reach its highest total fertility rate in more than a quarter of a century.

Queensland cut the deepest into its maternity services this decade, slashing 22 obstetric units and 16 specialist pediatric services, at a time when its population was booming.

Victoria lost 11 obstetrics and two neonatal intensive care units, while NSW closed down nine maternity units.

Only South Australia bucked the trend, retaining the same number of services for mother and child as it did at the start of the decade.

Women's & Children's Hospitals Australasia chief executive Elizabeth Chatham yesterday acknowledged planners had failed to pick the baby boom, but said hospitals had demand management strategies in place.

The federal government's $120 million budget package for maternity services, which boosted the role of midwives, would allow more creative ways of returning services closer to women's homes, she said.

"I think the policy to direct closures has relied on thinking of traditional models -- models provided by hospitals only -- when now we may be able to look at hospital services working together with community ones," Ms Chatham said.