Friday, November 6, 2009

things are looking grim for midwives

As I write, things are looking grim for midwives. We have talked a lot about the outrageous restriction on a midwife's ability to practise privately and autonomously, but it's worse than that. Our federal government is making laws that will completely redefine midwifery.

A new amendment in the Health Legislation Amendment (Midwife and Nurse Practitioner) bill will require eligible midwives to have a “collaborative arrangement” with a doctor in place at all times.

Midwives have always had collaborative arrangements, in that we consult with medical professionals and refer when we suspect illness or complication. We encourage women to make a booking at a hospital as back up, to access services if and when required.

However, the 'collaborative arrangement' foreshadowed in this legislation appears to be the mandating of a formally agreed relationship that covers every single episode of care provided by the midwife. This is the opposite of autonomous professional practice; it is external supervision of the midwife's practice - a medical veto over care.

No doctor in their right mind will agree to any arrangement that gives the midwife any responsibility in decision making. I don't know any doctor who I could ask to enter such a relationship with me.

In recent months several women coming to me for care have said their local GP was reluctant to be involved (by ordering blood tests) when they said they wanted to plan homebirth. They said the doctors thought they were not allowed to. This is likely to become more acute in coming months.

ALL MIDWIVES in Australia stand to lose if this legislation is passed. The person the Health Minister is concocting is a handmaiden, and obstetric assistant. Not a midwife, but this person will have the title midwife, and we midwives who have served our communities safey and effectively for generations will be made illegal.


  1. Thanks Joy for articulating the situation so clearly.
    This outrages me! I do not need to be supervised or given permission by a doctor to practice what I am already qualified & registered to do!!! Doctors are not the gatekeepers of birth or supervisors of midwifery.
    This has set the midwifery profession back years. ALL midwives should be equally outraged!

  2. Medical Observer, Friday 6th Nov:

    "The amendments to the nurse practitioner legislation will come as welcome relief for doctors, who feared that without mandated collaborative arrangements in place nurse practitioners would work independently and fragment care. AMA vice-president Dr Steve Hambleton, who sits on the Government’s Nurse Practitioner Advisory Group (NPAG), said the crucial amendment would ensure nurse practitioners were not supported to work in competition with doctors."

    Exchange nurse for midwife (it's the same legislation). An AMA rep on the advisory group ensuring that doctors are not losing their lucrative business to nurses & midwives. They are not worried about safety or fragmentation of care at all!


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