Over past months I have been recording events and my comments as we progress through uncharted waters of what is supposed to be maternity reform. There have been confusing and sometimes distressing messages, from a privately practising midwife's point of view. I can only imagine how women who value private midwifery service are feeling about it all. A blog is a good repository of information, and from time to time I scroll down through this and other blogs to be reminded and to get my facts straight.
Yesterday I attended a Stakeholders Forum in Canberra, auspiced by (and funded by) the National Health & Medical Research Council on Developing National Guidance on Collaborative Maternity Care. I attended as a representative of Midwives in Private Practice, and plan to write a report on the MiPP blog. It was a big day; I was up before 5 to get to the airport at 6.30.
In summary, the big issues at the moment are a midwife's insurance and our right to practice.
Insurance
We know that every midwife in Australia will be required by law to be insured in order to practise after 1 July next year.
We know that an exemption on this requirement will apply for 2 years to homebirth. The exemption is limited to the birth only.
We have been told, but are yet to see documentation, that an affordable insurance product will be available for midwives to purchase before 1 July, to cover their private midwifery practices (excluding birth).
Right to practice
This indicates that all midwives will be able to continue their private practices lawfully, as long as they have an indemnity insurance.
Rosemary Bryant, who is the health minister's Chief Nurse, confirmed this verbally to me yesterday. This reassurance is somewhat 'reassuring', but I will wait until I have seen the fine print. On face value it appears that midwives will be able to continue practising privately next year, IF ...!
My confidence has been jaded this year by the repeated episodes of this government adding new rules, new hoops to jump through - the most recent being the 'collaboration' amendment to the midwifery legislation. The amendment adds the condition that a midwife must have a "collaborative arrangement". The Health Minister told the parliament "These bills will mean that eligible midwives working in collaborative arrangements with obstetricians or GP obstetricians will be able to access the new government supported professional indemnity scheme."
What we don’t know yet is what this collaborative arrangement will look like. Doctors are not required to have collaborative arrangements with midwives. That sets up the likelihood that some midwives may not be able to practise because they are unable to get a doctor to give them the gold star of approval.
Noone has defined collaboration as it appears in this law.
Noone knows if the doctor’s insurer will support that doctor’s arrangement with midwives; if any legal action against the midwife will imply liability on the doctor’s part.
The point that the Minister, and her advisers, have not acknowledged is that midwives constantly collaborate with doctors, nurses, and other health professionals. It's written into our definition.
Witch hunts and midwives are sadly intertwined in our history. A writer to a midwives email list has proposed that the current attempt at micromanagement of all midwives who attend homebirths is another attempt to control and suppress women. By attempting to remove all midwives who are prepared to focus their attention on women, the system is tidying up that small but embarrassingly indominatable group (reminiscent of a certain fictional Gaulish village).
Midwives who are willing to be independent in their thought and reflective in their learning are also willing to stand their ground because they know that what they have to offer their community must not be relinquished.
