Medicare Rebates for midwives

On Tuesday 16th March the Australian Senate passed bills that enable eligible midwives to provide Medicare funded antenatal, birth and postnatal care and to be able to prescribe certain medicines under the Pharmaceutical Benefits Scheme (PBS). Medicare rebates are only available for birth in hospital. Rebates for prenatal and postnatal care will be available to all woman, including women birthing at home. The new Medicare Benefits Scheme for midwifery and PBS will commence the 1st November 2010. Details of what is an eligible midwife and how the new system is to work is yet to be announced. You can read more Maternity Service Reforms fact sheet released by the commonwealth government and a summary called the National Maternity Reform by the Australian College of Midwives.

National Day of Action

On the the 18th of February 2010, in 14 locations across Australia, 1000s of people gathered to register their protest at the Rudd Government's policies that threaten to restrict options for women giving birth. The choice of women to have a private midwife will at best be highly restricted and at worse impossible if the current changes go ahead.

GOVERNMENT BACKFLIP ON MIDWIVES

This article appeared in Australia.to yesterday afternoon. I feel like we've had a big win - so much for Mr 3am

Family First Leader Senator Steve Fielding has welcomed the decision by the Health Minister to back down on its controversial plan to drive homebirths underground.

Under the Government's original proposal, homebirths were to become illegal unless a midwife could find a doctor willing to work in collaboration with them.

But now the government says it won’t force midwives to work in formal collaborative arrangements with doctors as a condition of insurance.

"The Rudd Government's backflip proves they clearly underestimated how important this issue was to Australian women,” Senator Fielding said.

“Women should have the right to choose whether they want to have a birth in a hospital or at home, and midwives that assist in either case should be able to access affordable indemnity cover.

“The Rudd Government created this mess because it wouldn’t listen to the community and its concerns.

“All too often this Government is intent on ramming legislation though to suit their agenda without seriously considering the consequences.

“The Rudd Government acknowledges it made an error in essentially making homebirths illegal when it announced at the 11th hour that it would give homebirth midwives a two-year reprieve from its changes.

Now the government needs to guarantee that women will be able to continue giving birth at home with the assistance of a registered midwife once the two-year reprieve has expired.

“Numerous studies have shown that for low-risk women with appropriate transfer-to-hospital options available, homebirths are at least as safe as births in hospitals or birth centres.”
 

Midwives damn AMA-induced amendments to maternity reform

A fabulous article by Professor Lesley Barclay and Professor Sally Tracy

Senior midwifery research academics, including 19 professors and associate professors of midwifery, have signed an open letter raising serious concerns about the newly proposed amendments to Health Legislation (Midwives and Nurse Practitioners) Bill and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill.

These amendments are ill-informed, conflict with current regulation of the practice of midwives, and were promoted by a medical union (the AMA), rather than the craft groups most concerned and knowledgeable about women’s needs and safety at birth.

We and our colleagues are surprised and disturbed that pressure from a union rather than our medical colleagues has persuaded the government to make changes that are not informed by evidence, but appear to be based on protection of income and power.

We support reform of Australian maternity services — an area of long neglected policy by previous governments and health ministers.

To read the full article to go Crikey

My Birth My Choice Rally Sydney

Enjoy my photos from the My Birth My Choice Rally in Sydney 9th November 2009

Andrew Laming - Home Births

Senate ignores women’s pleas on homebirth – recommendation to pass legislation

Media Release: Senate ignores women’s pleas on homebirth – recommendation to pass legislation
Tuesday August 18, 2009.

Today’s Senate report into the Health Legislation Amendment (Midwife and Nurse Practitioner) Bill 2009 and two other related bills failed to support the calls of Australian women to ensure that they can access a registered midwife for birth care at home.

The report recognised the concerns of stakeholders that the intersection of two pieces of legislation - including legislation drafted by COAG on national registration - may have the “unintended consequence” of forcing homebirth underground. However it failed to recommend any solution for the crisis even though they received almost 2000 submissions on the issue and the report clearly identifies that there is a significant issue for women wanting to birth at home.

“We are not seeing the leadership needed to sort this issue out” President of the Australian Private Midwives Association Liz Wilkes said. “This is a good old case of state/Commonwealth buck passing going on. The states are saying the Commonwealth needs to find indemnity and the Senate are now saying that the problem is the state based legislation. In the meantime the clock is ticking for the women of Australia who in just over 10 months will be unable to access a registered midwife to care for them in birth at home.”

The advice from the Senate committee was that the Bill did not restrict women’s right to choose a homebirth nor make it unlawful.

“The use of language to skirt around this issue is amazing. Women in Australia are not in a third world country. They currently have registered midwives available to attend them in birth at home. However this government is choosing to ensure through a complex maze of legislation, that women will have to choose an unregistered care provider from July next year.

“The Federal Department of Health and Aging’s solution to this problem, which they outlined in evidence to the Senate, was for women to be attended at home by someone as long as they do not call themselves a midwife, or be registered as a midwife with the national regulatory body,” Ms Wilkes added. “We find this ridiculous.”

Midwives will face disciplinary action for attending homebirths under state based legislation which makes insurance mandatory for all health practitioners. If midwives de-register and continue to practice, using a midwifery title, they may face a $30,000 fine.

“Of course what we will see is a rise in non-midwives providing homebirth care which will compromise safety for mothers and their precious babies. The Australian Private Midwives’ Association does not believe the only choice available for women is to birth at home with an unregistered care provider.” Ms Wilkes stated. “The real concern is that the Senate heard no evidence to substantiate the government’s position, yet they will wave the legislation through. We definitely have to assume this is more to do with politics and less to do with women and safety.”

Media – Liz Wilkes President Australian Private Midwives Association 0423 580585

Government discriminating against home births, says Homebirth Australia

By Bonny Symons-Brown AAP

August 06, 2009 02:33pm

PROPOSED laws which would stop mothers from accessing registered midwives for homebirths would jeopardise the health of thousands of women and babies, a peak maternity group says.

Homebirth Australia (HA) is angry about a suite of bills introduced to Parliament by the Federal Government in June which propose, among other things, to establish a national midwifery register.

Under the draft laws, midwives must be insured to join the register but private insurers no longer provide cover for homebirthing and the Federal Government has also refused to subsidise professional indemnity for homebirth claims.

HA secretary Justine Caines said the draft laws effectively stop registered midwives legally attending home births.

"The national registration requirement is absolutely appropriate," she told a Senate inquiry into the legislation.

"What is not appropriate has been the (Health Minister Nicola Roxon's) response to say ...'I will enable the funding of one-to-one midwifery care through Medicare for midwives who care for women birthing in the hospital system, but I won't do it for homebirth'."

Despite this, Ms Caines gave the Government the benefit of the doubt, saying any discrimination against homebirthing was an unintended consequence of the registration process.

"I'm not saying that (Ms Roxon) deliberately set out to do this, not at all," she said.

"What she has done is made a giant step forward and been too scared to take the next step because of medical objection, because of the power of the medical lobby."

The Australian Medical Association has previously spoken out against homebirthing, warning it is significantly more dangerous than giving birth in a hospital. But Ms Caines said Labor's legislation would endanger pregnant women who were unable to access registered midwives for their homebirths.

"I don't care if it's 1000 women or 2000 women a year, (Ms Roxon) is putting women in great danger," she said.

"She is also saying 'Your rights don't matter'."

There were both physical and emotional advantages to giving birth at home, Ms Caines said.

"What has come through no doubt in the passion from the women is the ... amazing emotional wellbeing for that woman, for her whole family, but also it does actually impact on clinical wellbeing."

Australian Greens senator Rachel Siewert said draft laws effectively rendered homebirths illegal.

"Where there is a low-risk pregnancy it is safe to have a home birth and women and families need to be able to have that choice," she said.

The Greens will seek to amend the bills to ensure homebirthing with registered midwives remains an option for women in Australia.

From http://www.news.com.au/story/0,27574,25891706-29277,00.html

To all those in Australia concerned with maternity services

Quote by Marsden Wagner, M.D., M.S., for 15 years a Director of Women’s and Children’s Health, World Health Organisation

Childbirth is not a medical procedure, it is a normal part of the life cycle and belongs to women and their families, not to doctors nor hospitals nor the government. There is overwhelming scientific evidence that planned out-of-hospital birth attended by a midwife is an absolutely safe choice for all low-risk pregnant women---women without any serious medical problems. To in any way limit or forbid the choice of out-of-hospital birth or the training and ability to practice of midwives willing to attend out-of-hospital births is to deny Australians the freedom to control their own lives and is to fail to honor the central importance of family values in Australia.

In the 1980’s the German organization of obstetricians and gynecologists tried to get a national law forbidding planned out-of-hospital birth. The German women rose up and fought against it, there was an international outcry and the effort of the doctors failed and since then there has been a vast effort to promote out-of-hospital birth centers, increasing from one to the present over 100 such centers, all using midwives.

In the 1990’s the Hungarian organization of obstetricians and gynecologists tried to get their government to forbid planned out-of-hospital birth. The Hungarian women rose up and there was an international outcry and the effort of the doctors failed.

In the last decade, the government of Brazil tried to lower their very high caesarean section rate through working with the doctors and hospitals. When this did not succeed, the government of Brazil started up a national network of out-of-hospital birth centers staffed by midwives which are very popular and have quite reasonable caesarean section rates.

Efforts by doctors in Australia to prevent or limit in any way the option of planned home birth attended by midwives by completely falsely claiming, without any scientific evidence, that planned out-of-hospital is unsafe, will ultimately fail as the people of Australia cannot be fooled all the time and value their freedom too highly and Australia does not want an international outcry against them and to be seen as unable to prevent unjustified medical dominance of normal family life.

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”.

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.