Tuesday, January 12, 2010

continuing the countdown

The context of writing this post is that it's hot outside. Melbourne has sweltered yesterday and last night, and I am thankful for air conditioners in houses and cars. My thoughts go out to all mothers with new babies.

I have no new news since my last entry on this blog.

A couple of draft documents that will have an impact on the way midwives practise privately after 1 July this year have been circulated, and I am doing what I can to prepare responses. Other midwives and birth activists are also committing precious time to writing responses.

The most significant matter at the moment (from where I sit) is the exemption of birth from indemnity insurance. See the MiPP blog for the current news.

The big question is, Which midwives will be allowed to access the exemption from indemnity insurance?

The draft framework document once again raises the idea of mandatory
". evidence of formal arrangements for professional and medical backup as demonstrated by signed letter from collaboration partners"

This requirement itself would exclude most midwives from access to the exemption, unless the government also provided, at considerable cost, a bureaucratic system that established a process to tick the box - a silly notion. Even though I respect and from time to time work with various obstetricians, I don't have obstetricians who I could ask to give me a signed letter of collaboration. I and others will be arguing this in our submissions to the inquiry, and we believe we can use a letter from Health Minister Roxon in preventing this particular requirement from being adopted into regulatory processes.

I believe every midwife should be free to choose to work in a private, self employed capacity, practising midwifery. Therefore every midwife should be able to claim the exemption from indemnity insurance for attending birth, either in the woman's home or in hospital. Midwifery is a discreet scope of practice that limits what a midwife can, and cannot do.

Secondary regulation, which this draft framework is, can not be used to replace or preempt the basic regulation of the midwifery profession. There can be only one gatekeeper into the midwifery profession in a jurisdiction, and the body with that responsibility is the regulatory Board, which has the authority to investigate, take disciplinary action, and in extreme cases, remove or restrict the practice of a midwife. This grave responsibility cannot be delegated to insurance providers or other regulatory panels.

I think we, independent midwives, have to approach this framework as positively as we can. We are the privately practising midwives of Australia; we are legally registered to practise midwifery. We have already argued to the Health Minister and the Senate hearing why it is unreasonable to mandate the signed collaborative agreement, and those arguments, which appear to have achieved some significant changes, can be aired again. Midwives are able to produce evidence of collaborative practice (however it is defined). We draw the line on having double jeopardy at the hands of a competing profession, obstricians.

There continues to be a degree of uncertainty about how private midwifery will look after 1 July, when the government's reforms will come into effect. I am hopeful that there will continue to be a place for every midwife to attend women who choose their care, whether it's through publicly funded programs or privately.

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