New Pricing Level for MIGA Insurance

MIGA have announced a new pricing level for midwifery indemnity insurance. This price level was created in response to midwives requesting a lower premium for part time practices. While the premium is still out of the reach of midwives only attending a few women a year - it does make the product more affordable. 

The next step will be to see if they change the way they calculate the premium which is currently based on a 'per woman' basis. At the moment if I see one woman from the beginning of pregnancy through to 6 weeks after the birth - that woman is counted as one but if I see one woman for one postnatal visit (for example) - that woman is also counted as one. So 40 postnatal visits would be counted as 40 woman and the maximum premium needs to be paid. The way the Department of Health and Aging set the way insurance is structured for midwives doesn't reflect the way midwives work.

Supporting women in Public Hospitals after a homebirth transfer

This last fortnight has been quite stressful. It started with a report that a midwife had been reported for supporting a women in hospital who she gave a hot pack. The charge was she'd been practising midwifery without insurance. Then came a communication from MIGA (the insurance company) essentially saying that if a midwife stayed with a women after she transferred to hospital they would be in breach of their registration. This was shortly followed by a communication from the Australian College of Midwives basically saying the same thing. Yesterday sanity prevailed - Australian Health Practitioner Regulation Agency released a document clarifying this issue. You can find the official documentation on this page of AHPRAs website. Yes we can stay with a women who is admitted as a public patient as a support person. However the question of what constitutes midwifery care remains.

Midwifery in action.wmv

Midwifery in Action is a short video that provides a glimpse into what midwives do and the special relationship that can develop between midwives, women and their family. Anna, Marc and Baby Ben share their journey through pregnancy, birth and the postnatal period with midwifery care. You'll see the continuum of care through prenatal visits, a home waterbirth and postnatal care.

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.

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

Curbed midwives push to break free

Sydney Morning Herald

JULIE ROBOTHAM HEALTH EDITOR

November 9, 2009

MIDWIVES' ability to work independently - promised by the federal Health Minister, Nicola Roxon - would depend on endorsement by individual doctors under an amendment to proposed legislation that has infuriated women's groups.

Birth advocacy groups will rally today at sites across the country, including the Brisbane headquarters of the Prime Minister, Kevin Rudd, and in Sydney outside the Surry Hills office of the Minister for the Status of Women, Tanya Plibersek, to protest at the amendment, made public last week, which reveals that to work in private practice midwives will first have to ''enter a collaborative arrangement … with one or more medical practitioners''.

Critics say the Government has capitulated to doctors and the move undermines the intent of a series of bills before the Senate, which for the first time would allow midwives' clients to claim a Medicare rebate for their services.

It also threatens rural women's access to birth services, they say, and puts midwives at the mercy of sometimes hostile doctors for their professional registration, Medicare funding and indemnity insurance.

Hannah Dahlen, vice-president of the Australian College of Midwives, said the decision tied midwives' ability to practise ''to the sign-off as a doctor'' - contradicting the World Health Organisation's definition, which describes a midwife as an ''accountable professional [who can] conduct births on the midwife's own responsibility''.

Midwives accepted the need to collaborate, she said, but should be required to have working relationships with health services rather than individual doctors.

''There are particular issues in rural and remote Australia where sometimes there is no doctor, or no permanent doctor, just three-month locums,'' Associate Professor Dahlen said. ''This is not about safety, not about evidence. It's purely about politics. Collaboration's about mutual trust and respect. It's not about one profession choosing when another will or won't work.''

Professor Dahlen said the amendment could prevent new models of pregnancy and birth care envisioned in the law reform - such as midwives working in a group practice - from getting off the ground.

When she announced midwives would be given Medicare rights, Ms Roxon said the $67 million measure would ''improve the flexibility of the health workforce'' and allow patients better access to services.

The amendment is also likely to threaten women's ability to choose to give birth at home, if midwives cannot find a doctor to support them in such births.

Doctors groups - including the Australian Medical Association, which is understood to have campaigned hard for the amendment, and obstetricians' representatives - have been vocal in their opposition to home birth, saying it is unsafe.

Under current rules, midwives can manage home births but are not insured to do so and must disclose this to women. The new law would end this.

Alison Leemen, assistant co-ordinator of Homebirth Access Sydney, said the Government had ducked a potentially furious debate about doctors' veto over midwives.

''It doesn't enable the Senate to have proper scrutiny,'' Ms Leemen said.

''Regulations do not undergo nearly the same level of scrutiny as primary legislation. It's like signing a blank cheque.''

The threat to Homebirth Care with a Registered Midwife Explained

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.

Historic News

Australian College of Midwives
Media Release
“Mothers and Midwives Budget winners”

“Today is an historic day for childbearing women and their families in Australia,” said Associate Professor Hannah Dahlen, National Media Spokespersons for the Australian College of Midwives.

“Not only has the Rudd Government made the welcome commitment to parental leave to better support families with newborn babies, but they have also provided for:

• mothers to receive Medicare rebates for midwifery care,
• access to PBS for midwives,
• national collaborative maternity care guidelines,
• increased access at state level to birth centres,
• indemnity for midwives
• measures to enhance the access of rural and remote women to maternity care as close as possible to their home community.
• A national telephone support service for pregnant women and mothers of newborns

“These reforms will together make it much easier for women living anywhere in Australia – from the middle of our largest cities to remote communities - to access continuity of care by a known midwife” Assoc Prof Dahlen said. “They will also be vital in helping to close the gap on disadvantage for Aboriginal and Torres Strait Islander mothers and babies in partnership with Indigenous people themselves.”

Continuity of midwifery care involves a pregnant woman being cared for by a known midwife throughout her pregnancy, labour and birth. It also involves follow up care in the home for up to 6 weeks after the birth of the baby to provide professional support with the all important transition to parenting.

“This is not about substituting doctors with midwives” Assoc. Prof Dahlen said. “Obstetricians will, of course, continue to have a vital role in maternity care. Midwives providing continuity of care collaborate with obstetricians and allied health professionals throughout the episode of care, in response to the individual needs of each woman and her baby.”

Research evidence shows a range of benefits when women are cared for by known midwives from early in pregnancy till well after the birth. These include fewer admissions to hospital antenatally, less need for epidurals or for any pain relief, fewer episiotomies, more normal births, reduced need for their baby to be admitted to a special care nursery, more success with breastfeeding, and less vulnerability to postnatal depression or anxiety.

“Health Minister Nicola Roxon is to be commended for listening to Australian women during the recent national review of maternity services and for acting on the evidence that their needs could be better met with greater access to continuity of care by midwives, said Assoc Prof Dahlen

“These reforms pave the way for tens of thousands of women and their families to benefit from continuity of midwifery care while maintaining Australia’s solid record of safety for mothers and babies,” said Assoc. Professor Dahlen. “The confidence the government has expressed in midwives through these major reforms will be embraced by the profession around Australia.”

“Today the government has honoured women and motherhood in this country and recognised that ‘the hand that rocks the cradle’ does indeed ‘rule the world,’ and that we as a society need to support women and invest in the future– our children,” said Associate Professor Dahlen.

The Budget and Midwifery

Here is an excerpt from the budget in relation to midwifery. No coverage for homebirths as expected.

Improving Maternity Services Package

Expense ($m)

	2008‑09	2009‑10	2010‑11	2011‑12	2012‑13
Department of Health and Ageing	-	8.8	24.7	29.7	49.5
Medicare Australia	-	2.4	0.7	0.8	0.9
Total	-	11.2	25.4	30.5	50.4
Related capital ($m)
Medicare Australia	-	3.1	-	-	-

The Government will provide $120.5 million over four years for the introduction of Medicare‑supported midwifery services to provide greater choice for women during pregnancy, birthing and postnatal maternity care. This measure includes $3.1 million in capital funding in 2009‑10 for Medicare Australia.

The new arrangements will allow midwives to work as private practitioners, provide services subsidised by the Medical Benefits Schedule and prescribe medications subsidised under the Pharmaceutical Benefits Schedule. The Government will also provide subsidised medical indemnity for eligible midwives working in collaborative arrangements in hospitals and healthcare settings. To ensure that Australia maintains its strong record of safety and quality in maternity care, a safety and quality framework, including professional guidance and an advanced midwifery credentialing framework, will be developed. A new 24‑hour, seven‑days‑a‑week helpline will also be established to provide antenatal, birthing and postnatal maternity advice and information to women, partners and families during the ante‑natal period and up to 12 months following the birth of a child.

The measure will also assist women in rural and remote areas by expanding the Medical Specialist Outreach Assistance Program to provide integrated outreach maternity service teams for women in under serviced areas. The expanded teams will include midwives, obstetricians, general practitioners and other health professionals, such as paediatricians and Aboriginal health workers. Additionally, funding will be provided for the professional development of midwives and for general practitioners to undertake additional training to become GP obstetricians or GP anaesthetists. The package will be implemented progressively from 1 July 2009.

The Campaign Begins

Today I am beginning to coordinate a campaign in my local area to lobby to save the future of midwifery in private practice and homebirths. The Report of the Maternity Services Review failed to provide a provision for midwives attending homebirths nor to find a solution for professional indemnity insurance. As a requirement of national registration planned to be implemented mid 2010 - midwives will be asked to provide proof of professional indemnity insurance as to enable registration - as no insurance is available if midwives choose to attend a homebirth they will be practising illegally. Women have a right to a midwife attending them at home. More on my plans later. Enjoy this video produced by Homebirth Australia.

Photo and video editing at www.OneTrueMedia.com

Proverb Translated from the Tao Te Ching

You are a midwife, assisting at someone else's birth. Do good without show or fuss.

Facilitate what is happening rather than what you think ought to be happening.

If you must take the lead, lead so that the mother is helped, yet still free and in charge.

When the baby is born, the mother will rightly say: "We did it ourselves!"

from The Tao Te Ching

Greater Roll for Midwives

Midwifery is on the national agenda today. There has been wide coverage on television and newspapers. Finally we are seeing a shift by the government towards midwifery care. This is long overdue. My fingers are crossed the government is serious about implementing the planned changes.

Here is the report in today's Sydney Morning Herald (on the front page).

Mark Metherell - September 10, 2008

Midwives would be given doctor-style responsibilities such as being able to order diagnostic tests and prescribe drugs under proposals being considered by the Federal Government.

With a shortage of nurses and doctors straining maternity services at a time of near-record birth rates, the Minister for Health, Nicola Roxon, will release a discussion paper today proposing a boost in the role of Australia's 12,000 midwives.

The paper cites fragmented services, professional restrictions, funding problems and a lack of affordable indemnity insurance as barriers to greater use of midwives. Australia's use of independent midwives compares poorly to other developed countries, including New Zealand and Britain.

To provide a comprehensive service similar to that of general practitioner obstetricians, the discussion paper says, midwives require rights in hospitals to enable them to visit and refer their patients to specialists, to order diagnostic tests, prescribe drugs and have access to Medicare payments for the work they do.

The proposals are likely to encounter resistance from the Australian Medical Association, which has previously raised concerns about patient safety - claims that have been rejected by the Australian College of Midwives.

The discussion paper is part of a comprehensive review of maternity services being led by the Chief Nurse and Midwifery Officer, Rosemary Bryant, to be completed by the end of the year.

The review will cover issues including support for a greater role for midwives; opportunities for women to have more birth-care options, including home births; the shortage of maternity staff and services, particularly in rural and remote areas; and rising levels of post-natal depression.

The paper says that as there is no Medicare benefit payable to midwives for management of labour and delivery, there is only limited support for midwifery services through private health insurance.

In most cases, mothers choosing to have their babies outside hospital pay the full cost of midwife services, which is typically more than $1000.

A key issue was expanding the scope within both the public and private sectors for women "to achieve greater choice and increased continuity of care.

The report states that Australian women often had a range of different health-care providers during pregnancy.

This was despite international studies which had consistently demonstrated that continuity of carers improved satisfaction for both patient and carer, and improved health outcomes.

National Health and Hospital Reforms Commission

On 25 February 2008, the Prime Minister and the Minister for Health and Ageing announced the establishment of the National Health and Hospitals Reform Commission. The commission will provide a blue print for tackling future challenges in the Australian health system. Out of the blue I received an invitation to attend a focus group, which was one of many groups facilitated by the commissioners across Australia. They brought together a diverse group of front line health care providers such as midwives, physiotherapists, ambulance officers, dieticians, nurses, doctors, prison health care workers (and quite a few other professions). It was a very interesting few hours. We sat randomly at round tables and worked as a group to discuss what we wanted to see changed in the health care system. We each had the opportunity to present two changes. Then together as a group developed three changes for the future. Each table presented their ideas (there were five tables in all). Out of all the ideas collected we had to all agree on five changes. Then a table was assigned one of these changes and we had develop ideas on how to achieve these changes. It was a fascinating process and easy to contribute to. As health professionals I found we all have similar ideas of what was needed for the future. I had the opportunity to speak for improvements in maternity care and have some of my ideas included into the submissions to the commissioners. I spoke for the right of women to have publicly funded homebirths, for the care of well pregnant women to be available in the community (rather than by the hospitals), to change from an illness focus to a wellness focus in maternity care and for the need of midwives to have professional indemnity insurance. While I was only one voice - I did feel that I was listened to. I do commend the government for this initiative. However I hope the Australia Government doesn't just produced a blue print for the future, I hope they choose to act on it rather than filing it in the bottom draw. To find out more visit the National Health and Hospital Reforms Commission Website.

Save Independent Midwifery

Since 2003 Independent Midwives in Australia have been unable to obtain professional indemnity insurance. Insurance companies felt that the number of independent midwives is extremely small and that one claim would wipe out any premiums they'd obtain - making independent midwives an uneconomical group to support. As far as we can ascertain there have been no major claims against independent midwives (or none that the insurance companies have let us know about). This had a big impact on my independent midwifery practice. I'd enjoyed a wonderful working relationship with Prince Alfred Hospital at Camperdown - I had visiting rights as an independent midwife which enabled me to support women as their primary caregiver in the birth centre and also enabled me to continue care for women who required a transfer after a planned homebirth. In NSW the Nurses and Midwives Registration board does state that we are supposed to carry Professional Indemnity insurance but does not enforce it.

It seems that Independent Midwifery in the UK is not so fortunate. The government is proposing that all health professionals carry professional indemnity insurance - which effectively will make it illegal for independent midwives to continue practicing. I cannot believe that such problems face my sisters in the UK. If you wish to read more go to http://www.saveindependentmidwifery.org/